Provider Demographics
NPI:1619320595
Name:HANAKI, SHANNON HELM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:HELM
Last Name:HANAKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 CAROLYN SUE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5509
Mailing Address - Country:US
Mailing Address - Phone:225-928-9398
Mailing Address - Fax:225-928-9490
Practice Address - Street 1:1945 CAROLYN SUE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5509
Practice Address - Country:US
Practice Address - Phone:225-928-9398
Practice Address - Fax:225-928-9490
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA849103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent