Provider Demographics
NPI:1265091235
Name:KATIE SHANNON LICSW LLC
Entity type:Organization
Organization Name:KATIE SHANNON LICSW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:BRIANNE
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-572-3335
Mailing Address - Street 1:2224 1ST AVE W STE 4
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6286
Mailing Address - Country:US
Mailing Address - Phone:701-572-3335
Mailing Address - Fax:701-572-3337
Practice Address - Street 1:2224 1ST AVE W STE 4
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6286
Practice Address - Country:US
Practice Address - Phone:701-572-3335
Practice Address - Fax:701-572-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty