Provider Demographics
NPI:1518261973
Name:SHANNON, JOSHUA ELLIOTT (PHD, LMHC, CRC, CEAP)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ELLIOTT
Last Name:SHANNON
Suffix:
Gender:M
Credentials:PHD, LMHC, CRC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 W BAY TO BAY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8100
Mailing Address - Country:US
Mailing Address - Phone:877-957-3422
Mailing Address - Fax:813-835-1722
Practice Address - Street 1:2909 W BAY TO BAY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8100
Practice Address - Country:US
Practice Address - Phone:877-957-3422
Practice Address - Fax:813-835-1722
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8185101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional