Provider Demographics
NPI:1780447813
Name:KATRINA SHANNON, LMFT, PLLC
Entity type:Organization
Organization Name:KATRINA SHANNON, LMFT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:630-216-9104
Mailing Address - Street 1:2 MID AMERICA PLZ STE 110
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4711
Mailing Address - Country:US
Mailing Address - Phone:630-216-9104
Mailing Address - Fax:
Practice Address - Street 1:2 MID AMERICA PLZ STE 110
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4711
Practice Address - Country:US
Practice Address - Phone:630-216-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty