Provider Demographics
NPI:1457020877
Name:SHANNON CONNELL, PH.D., LLC
Entity Type:Organization
Organization Name:SHANNON CONNELL, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-396-4846
Mailing Address - Street 1:36 W 8TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-2702
Mailing Address - Country:US
Mailing Address - Phone:616-396-4846
Mailing Address - Fax:616-396-4846
Practice Address - Street 1:36 W 8TH ST STE 200
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2702
Practice Address - Country:US
Practice Address - Phone:616-396-4846
Practice Address - Fax:616-396-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty