Provider Demographics
NPI:1336616739
Name:SHANNON, MICHELLE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 RIDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3598
Mailing Address - Country:US
Mailing Address - Phone:214-762-7990
Mailing Address - Fax:
Practice Address - Street 1:5601 DEMOCRACY DR STE 135
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3672
Practice Address - Country:US
Practice Address - Phone:469-301-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional