Provider Demographics
NPI:1477255875
Name:RODGERS, SHANNA (LCPC)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 PARKHILL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3067
Mailing Address - Country:US
Mailing Address - Phone:406-647-0302
Mailing Address - Fax:
Practice Address - Street 1:1645 PARKHILL DR STE 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3067
Practice Address - Country:US
Practice Address - Phone:406-647-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-45114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health