Provider Demographics
NPI:1508049768
Name:PANTALIONO, SHAWN (MS, EDS, LPCC-S)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:PANTALIONO
Suffix:
Gender:M
Credentials:MS, EDS, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BEACON HL
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1247
Mailing Address - Country:US
Mailing Address - Phone:859-321-0335
Mailing Address - Fax:
Practice Address - Street 1:713 MILLPOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1570
Practice Address - Country:US
Practice Address - Phone:859-309-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY127774101Y00000X
KY245129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor