Provider Demographics
NPI:1942792130
Name:MCBRIDE, SHANNON SUSANNE (LPC/MHSP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:SUSANNE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8848 CEDAR SPRINGS LN STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5416
Mailing Address - Country:US
Mailing Address - Phone:865-212-6600
Mailing Address - Fax:865-313-2149
Practice Address - Street 1:8848 CEDAR SPRINGS LN STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5416
Practice Address - Country:US
Practice Address - Phone:865-212-6600
Practice Address - Fax:865-313-2149
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional