Provider Demographics
NPI:1871040311
Name:BEST, SHANNON (MA, LLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BEST
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11735 E STATE ROAD 8
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:IN
Mailing Address - Zip Code:46511-9551
Mailing Address - Country:US
Mailing Address - Phone:574-933-1900
Mailing Address - Fax:
Practice Address - Street 1:11735 E STATE ROAD 8
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:IN
Practice Address - Zip Code:46511-9551
Practice Address - Country:US
Practice Address - Phone:574-933-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1484174101YS0200X
MI6301010614103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling