Provider Demographics
NPI:1942590146
Name:ROBERTSON, SHANNON YVETTE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:YVETTE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7617
Mailing Address - Country:US
Mailing Address - Phone:512-635-3135
Mailing Address - Fax:512-868-3597
Practice Address - Street 1:1474 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7617
Practice Address - Country:US
Practice Address - Phone:512-635-3135
Practice Address - Fax:512-868-3597
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional