Provider Demographics
NPI:1972578706
Name:SHANNON, BARBARA (LMHP CPC LADC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LMHP CPC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 FLACK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3511
Mailing Address - Country:US
Mailing Address - Phone:308-762-6868
Mailing Address - Fax:308-762-3885
Practice Address - Street 1:321 FLACK AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3511
Practice Address - Country:US
Practice Address - Phone:308-762-6868
Practice Address - Fax:308-762-3885
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE431101YA0400X
NE2081101YM0800X
NE1192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84707Medicare UPIN
NE139107Medicare UPIN