Provider Demographics
NPI:1245660471
Name:MOUNT, SHANNON M (LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:MOUNT
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 MALLARD XING
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7493
Mailing Address - Country:US
Mailing Address - Phone:812-752-7577
Mailing Address - Fax:
Practice Address - Street 1:1482 MALLARD XING
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7493
Practice Address - Country:US
Practice Address - Phone:812-595-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003952A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical