Provider Demographics
NPI:1578227310
Name:GALVIN, SHANNON LYNN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:GALVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3798 MARSHALL ST STE 7
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6458
Mailing Address - Country:US
Mailing Address - Phone:720-808-1497
Mailing Address - Fax:
Practice Address - Street 1:3798 MARSHALL ST STE 7
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6458
Practice Address - Country:US
Practice Address - Phone:720-808-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health