Provider Demographics
NPI:1578959003
Name:LOVERN, SHANNON DAWN (CAS)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:DAWN
Last Name:LOVERN
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 STRIKER DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-4721
Mailing Address - Country:US
Mailing Address - Phone:970-275-1649
Mailing Address - Fax:
Practice Address - Street 1:2956 NORTH AVE STE 6
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-3919
Practice Address - Country:US
Practice Address - Phone:970-275-1649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008112101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)