Provider Demographics
NPI:1255101820
Name:NELSON, SHANNON RENE (LPCC, PPSC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPCC, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 CONDE LN APT 55
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8581
Mailing Address - Country:US
Mailing Address - Phone:805-423-2461
Mailing Address - Fax:
Practice Address - Street 1:9001 CONDE LN APT 55
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8581
Practice Address - Country:US
Practice Address - Phone:805-423-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC14708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional