Provider Demographics
NPI:1134917917
Name:HENDERSON, SHANNON BARBARA (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BARBARA
Last Name:HENDERSON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MARION ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1225
Mailing Address - Country:US
Mailing Address - Phone:570-921-3275
Mailing Address - Fax:
Practice Address - Street 1:200 MARION ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:PA
Practice Address - Zip Code:18421-1225
Practice Address - Country:US
Practice Address - Phone:570-921-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018546101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty