Provider Demographics
NPI:1912196569
Name:GARRITY, SHANNON KAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KAY
Last Name:GARRITY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 UNIVERSITY AVE W
Mailing Address - Street 2:202
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1769
Mailing Address - Country:US
Mailing Address - Phone:612-703-8589
Mailing Address - Fax:
Practice Address - Street 1:2388 UNIVERSITY AVE W
Practice Address - Street 2:202
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1769
Practice Address - Country:US
Practice Address - Phone:612-703-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4716103TB0200X, 103TC0700X, 103TC1900X, 103TE1100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy