Provider Demographics
NPI:1467897165
Name:KELLEY, SHANNON (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 RIVERWOOD CT
Mailing Address - Street 2:BLDG 1
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2811
Mailing Address - Country:US
Mailing Address - Phone:936-521-6484
Mailing Address - Fax:
Practice Address - Street 1:1020 RIVERWOOD CT
Practice Address - Street 2:BLDG 1
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2811
Practice Address - Country:US
Practice Address - Phone:936-521-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health