Provider Demographics
NPI:1184310781
Name:O'TOOLE, SHANNON (LMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-0017
Mailing Address - Country:US
Mailing Address - Phone:315-217-6888
Mailing Address - Fax:
Practice Address - Street 1:3460 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-0017
Practice Address - Country:US
Practice Address - Phone:315-217-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013374-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health