Provider Demographics
NPI:1922604412
Name:SAMUELS, SHANNON M (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1413
Mailing Address - Country:US
Mailing Address - Phone:570-885-8407
Mailing Address - Fax:
Practice Address - Street 1:5 LUZERNE AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2828
Practice Address - Country:US
Practice Address - Phone:570-885-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional