Provider Demographics
NPI:1609154533
Name:SHANNON, RICHARD ALLEN (MA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:SHANNON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-3663
Mailing Address - Country:US
Mailing Address - Phone:775-560-5326
Mailing Address - Fax:
Practice Address - Street 1:180 COUNTRY ESTATES CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4013
Practice Address - Country:US
Practice Address - Phone:775-560-5326
Practice Address - Fax:775-409-3226
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist