Provider Demographics
NPI:1356396998
Name:SHANNON, NANCY LYNN (PSYD LMFT)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYNN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PSYD LMFT
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 39
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-0039
Mailing Address - Country:US
Mailing Address - Phone:760-488-5054
Mailing Address - Fax:760-488-5059
Practice Address - Street 1:41865 BOARDWALK STE 217
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9033
Practice Address - Country:US
Practice Address - Phone:760-488-5054
Practice Address - Fax:760-488-5059
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC7912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist