Provider Demographics
NPI:1558406165
Name:BANUELOS, SHANNON LEANN (MAED COUNSELING)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEANN
Last Name:BANUELOS
Suffix:
Gender:F
Credentials:MAED COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1016
Mailing Address - Country:US
Mailing Address - Phone:480-497-3300
Mailing Address - Fax:
Practice Address - Street 1:8045 E PORTOBELLO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-1690
Practice Address - Country:US
Practice Address - Phone:480-507-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool