Provider Demographics
NPI:1700392776
Name:RICHMOND, SHANNON LYNN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 HAMLINE AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5571
Mailing Address - Country:US
Mailing Address - Phone:651-583-5565
Mailing Address - Fax:651-583-5566
Practice Address - Street 1:2151 HAMLINE AVE N STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4226
Practice Address - Country:US
Practice Address - Phone:651-583-5565
Practice Address - Fax:651-583-5566
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01914101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health