Provider Demographics
NPI:1659743581
Name:O'SULLIVAN, SHANNON M (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MERLINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1567
Mailing Address - Country:US
Mailing Address - Phone:814-806-5406
Mailing Address - Fax:814-920-7108
Practice Address - Street 1:17 MERLINE AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1567
Practice Address - Country:US
Practice Address - Phone:814-806-5406
Practice Address - Fax:814-920-7108
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1518473891OtherGROUP NPI