Provider Demographics
NPI:1881445856
Name:LOVE, SHANNON LEE (MS, LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:LOVE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 CLEAR MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-7386
Mailing Address - Country:US
Mailing Address - Phone:214-334-0469
Mailing Address - Fax:
Practice Address - Street 1:1325 CLEAR MEADOW CT
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7386
Practice Address - Country:US
Practice Address - Phone:214-334-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional