Provider Demographics
NPI:1790457943
Name:PIVONEY, SHANNON E (LCPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:PIVONEY
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 1:216 STUTELY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5234
Mailing Address - Country:US
Mailing Address - Phone:217-816-9071
Mailing Address - Fax:
Practice Address - Street 1:270 W PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1221
Practice Address - Country:US
Practice Address - Phone:217-816-9071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health