Provider Demographics
NPI:1598897712
Name:NOON, SHANNON (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:NOON
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 1:1515 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-532-1573
Mailing Address - Fax:406-532-1541
Practice Address - Street 1:1515 FAIRVIEW AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-532-1573
Practice Address - Fax:406-532-1541
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional