Provider Demographics
NPI:1487214318
Name:MASON, SHANNON MICHELE (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELE
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12906 COUNTY ROAD 3500
Mailing Address - Street 2:
Mailing Address - City:SLATON
Mailing Address - State:TX
Mailing Address - Zip Code:79364-7977
Mailing Address - Country:US
Mailing Address - Phone:806-470-1215
Mailing Address - Fax:
Practice Address - Street 1:6202 IOLA AVE STE 137
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2729
Practice Address - Country:US
Practice Address - Phone:806-470-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional