Provider Demographics
NPI:1578814554
Name:STORY, SHANNON NICOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:NICOLE
Last Name:STORY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2001 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-6260
Mailing Address - Country:US
Mailing Address - Phone:936-633-5676
Mailing Address - Fax:936-633-5695
Practice Address - Street 1:2001 S MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-6260
Practice Address - Country:US
Practice Address - Phone:936-633-5676
Practice Address - Fax:936-633-5695
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional