Provider Demographics
NPI:1881817807
Name:BRENT, SHANNON (BS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BRENT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N ZANG BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4528
Mailing Address - Country:US
Mailing Address - Phone:214-948-2439
Mailing Address - Fax:214-948-2474
Practice Address - Street 1:101 N ZANG BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4528
Practice Address - Country:US
Practice Address - Phone:214-948-2439
Practice Address - Fax:214-948-2474
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical