Provider Demographics
NPI:1952171233
Name:SEYMOUR, SHANNON (PLPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SEYMOUR
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 1:305 LAC IBERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4294
Mailing Address - Country:US
Mailing Address - Phone:504-264-3556
Mailing Address - Fax:
Practice Address - Street 1:305 LAC IBERVILLE DR
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4294
Practice Address - Country:US
Practice Address - Phone:504-264-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health