Provider Demographics
NPI:1649739079
Name:NIXON, SHANNON GWYN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:GWYN
Last Name:NIXON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ANDERSON CT
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3854
Mailing Address - Country:US
Mailing Address - Phone:720-469-0644
Mailing Address - Fax:
Practice Address - Street 1:72 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3415
Practice Address - Country:US
Practice Address - Phone:720-469-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional