Provider Demographics
NPI:1508056920
Name:WELCH GROVES, SHANNON TRACY (LMHC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:TRACY
Last Name:WELCH GROVES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:TRACY
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2929 WESTOWN PARKWAY
Mailing Address - Street 2:SUITE 110 DES MOINES PASTORAL COUNSELING CENTER
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50261
Mailing Address - Country:US
Mailing Address - Phone:515-274-4006
Mailing Address - Fax:515-255-5697
Practice Address - Street 1:2929 WESTOWN PARKWAY
Practice Address - Street 2:SUITE 110 DES MOINES PASTORAL COUNSELING CENTER
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50261
Practice Address - Country:US
Practice Address - Phone:515-274-4006
Practice Address - Fax:515-255-5697
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health