Provider Demographics
NPI:1134590730
Name:FERRY BRANAUGH, SHANNON E (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:FERRY BRANAUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 WILLAMETTE ST STE 407A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2696
Mailing Address - Country:US
Mailing Address - Phone:541-209-0289
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:541 WILLAMETTE ST STE 407A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2696
Practice Address - Country:US
Practice Address - Phone:541-209-0289
Practice Address - Fax:999-999-9999
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR104100000X
ORL105321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL10532OtherLCSW LICENSE