Provider Demographics
NPI:1932886926
Name:MOSELEY, SHANNON (LPC-S LPCC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:LPC-S LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 HONDO PASS DRIVE 1D
Mailing Address - Street 2:#266
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-1456
Mailing Address - Country:US
Mailing Address - Phone:325-227-5961
Mailing Address - Fax:
Practice Address - Street 1:14717 TIERRA HAVEN AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938
Practice Address - Country:US
Practice Address - Phone:915-209-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health