Provider Demographics
NPI:1609451228
Name:MCPHERSON, SHIANNE LIERIN
Entity Type:Individual
Prefix:
First Name:SHIANNE
Middle Name:LIERIN
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 WOODLAND HILLS DR APT 623
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4667
Mailing Address - Country:US
Mailing Address - Phone:903-413-1588
Mailing Address - Fax:
Practice Address - Street 1:17 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5625
Practice Address - Country:US
Practice Address - Phone:719-636-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health