Provider Demographics
NPI:1679975643
Name:BARNES, SHANNON (LPCI)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 NW 185TH AVE STE 316
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3406
Mailing Address - Country:US
Mailing Address - Phone:971-708-0083
Mailing Address - Fax:
Practice Address - Street 1:2412 NW ROSEBURG TER
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8118
Practice Address - Country:US
Practice Address - Phone:503-708-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No372600000XNursing Service Related ProvidersAdult Companion