Provider Demographics
NPI:1003354317
Name:SHEPHERD, SHANNON GUNNIP (LMHC, LPCC, LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:GUNNIP
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LMHC, LPCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-0179
Mailing Address - Country:US
Mailing Address - Phone:929-373-3747
Mailing Address - Fax:
Practice Address - Street 1:19 UNION SQ W
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3304
Practice Address - Country:US
Practice Address - Phone:212-627-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2023-12-05
Deactivation Date:2019-03-19
Deactivation Code:
Reactivation Date:2020-09-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health