Provider Demographics
NPI:1801806773
Name:EASTERLY, SHANNON (LCMFT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:EASTERLY
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 SHAWNEE MISSION PKWY
Mailing Address - Street 2:STE 102
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4031
Mailing Address - Country:US
Mailing Address - Phone:913-488-4370
Mailing Address - Fax:
Practice Address - Street 1:6811 SHAWNEE MISSION PKWY
Practice Address - Street 2:STE 102
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4031
Practice Address - Country:US
Practice Address - Phone:913-488-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS686106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist