Provider Demographics
NPI:1851789465
Name:SHIRLEY, SHANNON RAE (MS, LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAE
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:MS, LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0730
Mailing Address - Country:US
Mailing Address - Phone:406-255-8481
Mailing Address - Fax:406-657-3735
Practice Address - Street 1:1042 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0730
Practice Address - Country:US
Practice Address - Phone:406-255-8481
Practice Address - Fax:406-657-3735
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC-LAC-LIC-1406101YA0400X
MTSWP-LCPC-LIC-2435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)