Provider Demographics
NPI:1780871806
Name:WILDER, SHANNA LEIGH (LPC-S)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:LEIGH
Last Name:WILDER
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:MRS
Other - First Name:SHANNA
Other - Middle Name:LEIGH
Other - Last Name:MONAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S
Mailing Address - Street 1:7800 PRESTON RD STE 144
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3239
Mailing Address - Country:US
Mailing Address - Phone:972-251-0313
Mailing Address - Fax:
Practice Address - Street 1:7800 PRESTON RD STE 144
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3239
Practice Address - Country:US
Practice Address - Phone:972-251-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60443101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional