Provider Demographics
NPI:1912316985
Name:O'CONNELL, SHANNON L (PLPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2149
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-2149
Mailing Address - Country:US
Mailing Address - Phone:573-286-0108
Mailing Address - Fax:
Practice Address - Street 1:111 CROSSINGS W STE 5
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8749
Practice Address - Country:US
Practice Address - Phone:573-286-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015000875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional