Provider Demographics
NPI:1689063000
Name:MCNABB, SHANNON (LCPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MCNABB
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2632
Mailing Address - Country:US
Mailing Address - Phone:406-249-6437
Mailing Address - Fax:
Practice Address - Street 1:4520 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76137-2632
Practice Address - Country:US
Practice Address - Phone:406-249-6437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-8346101Y00000X
TX74821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor