Provider Demographics
NPI:1568059764
Name:NAIL, SHANNON LEA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEA
Last Name:NAIL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 BOODY RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:IL
Mailing Address - Zip Code:62544-8025
Mailing Address - Country:US
Mailing Address - Phone:217-836-3766
Mailing Address - Fax:
Practice Address - Street 1:210 W MCKINLEY AVE STE 1
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-5858
Practice Address - Country:US
Practice Address - Phone:217-329-3255
Practice Address - Fax:217-329-3319
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional