Provider Demographics
NPI:1720730153
Name:AGEE-JONES, SHANNON R (PCLC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:AGEE-JONES
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4616
Mailing Address - Country:US
Mailing Address - Phone:406-431-3593
Mailing Address - Fax:
Practice Address - Street 1:1096 ALDER CREEK DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7200
Practice Address - Country:US
Practice Address - Phone:406-431-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-48958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health