Provider Demographics
NPI:1700411071
Name:AKSEL, SHANNON KAY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAY
Last Name:AKSEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:KAY
Other - Last Name:TARBUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1226 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-3119
Mailing Address - Country:US
Mailing Address - Phone:267-417-8167
Mailing Address - Fax:
Practice Address - Street 1:1226 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-3119
Practice Address - Country:US
Practice Address - Phone:267-417-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional