Provider Demographics
NPI:1952592305
Name:ORTIZ, SHANNON L (LPCCS)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:L
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PERRY DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-5048
Mailing Address - Country:US
Mailing Address - Phone:330-846-3630
Mailing Address - Fax:
Practice Address - Street 1:1111 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-3601
Practice Address - Country:US
Practice Address - Phone:330-846-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM0700002106H00000X
OHC0600135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist