Provider Demographics
NPI:1841774502
Name:HARRIS, SHANNON L (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5095 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-6808
Mailing Address - Country:US
Mailing Address - Phone:307-331-2862
Mailing Address - Fax:
Practice Address - Street 1:150 E 29TH ST STE 215
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2765
Practice Address - Country:US
Practice Address - Phone:970-669-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099233161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical