Provider Demographics
NPI:1619644929
Name:PATRICK SHANNON, LCSW, PLLC
Entity Type:Organization
Organization Name:PATRICK SHANNON, LCSW, PLLC
Other - Org Name:PATRICK SHANNON, LCSW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-763-6611
Mailing Address - Street 1:PO BOX 801
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-0801
Mailing Address - Country:US
Mailing Address - Phone:406-763-6611
Mailing Address - Fax:
Practice Address - Street 1:3700 S RUSSELL ST STE B110
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8574
Practice Address - Country:US
Practice Address - Phone:406-763-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty