Provider Demographics
NPI:1841203684
Name:MUNSON, SHAWNA NICOLE (PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:NICOLE
Last Name:MUNSON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W 2ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3905
Mailing Address - Country:US
Mailing Address - Phone:308-534-3351
Mailing Address - Fax:308-696-3801
Practice Address - Street 1:221 W 2ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3905
Practice Address - Country:US
Practice Address - Phone:308-534-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025218100Medicaid