Provider Demographics
NPI:1932118742
Name:LATTIMORE, SHANNON PURTELL (LPC SUPERVISOR)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:PURTELL
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:LPC SUPERVISOR
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:PURTELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4801 FRANKFORD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5329
Mailing Address - Country:US
Mailing Address - Phone:469-620-6860
Mailing Address - Fax:
Practice Address - Street 1:9304 FOREST LN
Practice Address - Street 2:#100 SOUTH
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6238
Practice Address - Country:US
Practice Address - Phone:214-340-0208
Practice Address - Fax:214-340-7092
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health