Provider Demographics
NPI:1972676963
Name:SUMRALL, SHANNON LARRY (LPC)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:LARRY
Last Name:SUMRALL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 S CLAIBORNE AVE
Mailing Address - Street 2:SUITE 422
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4142
Mailing Address - Country:US
Mailing Address - Phone:512-207-0549
Mailing Address - Fax:
Practice Address - Street 1:3631 CONSTANCE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2515
Practice Address - Country:US
Practice Address - Phone:504-648-7036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3109101YP2500X
TX19687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175767601Medicaid
TX175767601Medicaid