Provider Demographics
NPI:1972178929
Name:GUTHEIL, SHANNON E (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:E
Last Name:GUTHEIL
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 1:1603 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4155
Mailing Address - Country:US
Mailing Address - Phone:970-222-8399
Mailing Address - Fax:
Practice Address - Street 1:1603 AVONDALE DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4155
Practice Address - Country:US
Practice Address - Phone:970-222-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69937101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor