Provider Demographics
NPI:1811085954
Name:JENNINGS, SHANNON SHEEHAN (LMHC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:SHEEHAN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:STAR
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-0256
Mailing Address - Country:US
Mailing Address - Phone:574-532-3178
Mailing Address - Fax:
Practice Address - Street 1:1170 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-3926
Practice Address - Country:US
Practice Address - Phone:574-532-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019668101YM0800X
IN39001654A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000383569OtherANTHEM
IN300048927Medicaid