Provider Demographics
NPI:1275937252
Name:SHANNON, PAULA (LCPC, LMFT, LCADC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:
Credentials:LCPC, LMFT, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-0280
Mailing Address - Country:US
Mailing Address - Phone:501-352-4178
Mailing Address - Fax:702-442-9615
Practice Address - Street 1:5510 S. FT. APACHE RD
Practice Address - Street 2:#220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-858-6455
Practice Address - Fax:702-442-9615
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0880106H00000X
NVCP1217101YM0800X, 101YP2500X
ARP2306014101YM0800X
NV3059106H00000X
NV00553-LC101YA0400X
ARM2312001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250004786Medicaid
NV25004789Medicaid
NV71853Medicaid