Provider Demographics
NPI:1912445164
Name:FRANCOM, SHANNON KAYE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KAYE
Last Name:FRANCOM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BRIGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3806
Mailing Address - Country:US
Mailing Address - Phone:801-318-4334
Mailing Address - Fax:
Practice Address - Street 1:1115 BRIGHAM DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-3806
Practice Address - Country:US
Practice Address - Phone:801-318-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist