Provider Demographics
NPI:1952825606
Name:NOPPER, SHANNON (LPC, LAC, NCC, LLC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:NOPPER
Suffix:
Gender:F
Credentials:LPC, LAC, NCC, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 GARDEN OF THE GODS RD STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4248
Practice Address - Country:US
Practice Address - Phone:719-215-5125
Practice Address - Fax:719-377-6494
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000990101YA0400X
COLPC.0014274101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000166040Medicaid