Provider Demographics
NPI:1609335256
Name:TOBABEN, SHANNON (LCPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:TOBABEN
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 1:6520 W 110TH ST STE 200A1
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1898
Mailing Address - Country:US
Mailing Address - Phone:913-735-5221
Mailing Address - Fax:
Practice Address - Street 1:6520 W 110TH ST STE 200A1
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1898
Practice Address - Country:US
Practice Address - Phone:913-735-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2932101YM0800X
WI10248-125101YP2500X
KS03187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health