Provider Demographics
NPI:1669027926
Name:CULLERS, SHANNON LYNN (MED, LADAC II)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:CULLERS
Suffix:
Gender:F
Credentials:MED, LADAC II
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LYNN
Other - Last Name:GENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LADAC
Mailing Address - Street 1:446 METROPLEX DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3186
Mailing Address - Country:US
Mailing Address - Phone:615-970-6260
Mailing Address - Fax:615-970-6267
Practice Address - Street 1:446 METROPLEX DR STE 200A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3139
Practice Address - Country:US
Practice Address - Phone:615-970-6260
Practice Address - Fax:615-970-6267
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1912465121Medicaid