Provider Demographics
NPI:1932756780
Name:KRATKY, SHANNON A (MS, LPC, LCDC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:A
Last Name:KRATKY
Suffix:
Gender:F
Credentials:MS, LPC, LCDC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CHERRY RIDGE DR STE C316
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4823
Mailing Address - Country:US
Mailing Address - Phone:210-791-7017
Mailing Address - Fax:830-323-0144
Practice Address - Street 1:3201 CHERRY RIDGE DR STE C316
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4823
Practice Address - Country:US
Practice Address - Phone:210-791-7017
Practice Address - Fax:830-323-0144
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15007101YA0400X
TX81460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)