Provider Demographics
NPI:1932434826
Name:DURHAM, SHANNON MAHON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MAHON
Last Name:DURHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N HAYDEN RD
Mailing Address - Street 2:# 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6652
Mailing Address - Country:US
Mailing Address - Phone:480-245-9942
Mailing Address - Fax:
Practice Address - Street 1:3200 N HAYDEN RD
Practice Address - Street 2:# 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6652
Practice Address - Country:US
Practice Address - Phone:480-245-9942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW - 120251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical