Provider Demographics
NPI:1255709291
Name:CREME, SHANNON (CPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CREME
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 RIVER HILLS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1791
Mailing Address - Country:US
Mailing Address - Phone:702-731-0909
Mailing Address - Fax:
Practice Address - Street 1:11109 RIVER HILLS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1791
Practice Address - Country:US
Practice Address - Phone:702-731-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1255709291OtherNPI
NV100543107Medicaid