Provider Demographics
NPI:1942427448
Name:ZANDER, SHANNON DENISE (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DENISE
Last Name:ZANDER
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 1:5020 LAKELAND CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2996
Mailing Address - Country:US
Mailing Address - Phone:254-265-5044
Mailing Address - Fax:254-399-9290
Practice Address - Street 1:5020 LAKELAND CIR
Practice Address - Street 2:SUITE B
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2996
Practice Address - Country:US
Practice Address - Phone:254-265-5044
Practice Address - Fax:254-399-9290
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145797003Medicaid