Provider Demographics
NPI:1770821944
Name:MILLER, SHANNON M
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 W KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68524-1320
Mailing Address - Country:US
Mailing Address - Phone:772-584-0452
Mailing Address - Fax:402-261-3661
Practice Address - Street 1:4600 VALLEY RD STE 330
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4855
Practice Address - Country:US
Practice Address - Phone:772-584-0452
Practice Address - Fax:402-261-3661
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21281101YM0800X
NE2876101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health