Provider Demographics
NPI:1689861981
Name:SERRANO, SHANNON LEIGH (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEIGH
Last Name:SERRANO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 N HAYDEN RD
Mailing Address - Street 2:#101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6649
Mailing Address - Country:US
Mailing Address - Phone:480-804-0326
Mailing Address - Fax:
Practice Address - Street 1:3260 N HAYDEN RD
Practice Address - Street 2:#101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6649
Practice Address - Country:US
Practice Address - Phone:480-804-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-2263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health