Provider Demographics
NPI:1780337642
Name:BRIMER, SHANNON (BA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BRIMER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 HWY 267
Mailing Address - Street 2:SUITE C
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161
Mailing Address - Country:US
Mailing Address - Phone:530-414-3851
Mailing Address - Fax:530-544-3167
Practice Address - Street 1:9709 HWY 267
Practice Address - Street 2:SUITE C
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161
Practice Address - Country:US
Practice Address - Phone:530-414-3851
Practice Address - Fax:530-544-3167
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health