Provider Demographics
NPI:1982064705
Name:SHANNON SAWYER, PLLC
Entity Type:Organization
Organization Name:SHANNON SAWYER, PLLC
Other - Org Name:SAWYER BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:915-533-8696
Mailing Address - Street 1:4150 RIO BRAVO ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4150 RIO BRAVO ST
Practice Address - Street 2:SUITE 225
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1055
Practice Address - Country:US
Practice Address - Phone:915-533-8696
Practice Address - Fax:915-234-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67787101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310648602Medicaid