Provider Demographics
NPI:1528414307
Name:GOOCH, SHANNON (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GOOCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8828 N STEMMONS FWY
Mailing Address - Street 2:#225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3719
Mailing Address - Country:US
Mailing Address - Phone:469-227-7847
Mailing Address - Fax:
Practice Address - Street 1:8828 N STEMMONS FWY
Practice Address - Street 2:#225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3719
Practice Address - Country:US
Practice Address - Phone:469-227-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional