| Doctor Name: | SHANNA DENISE EZELL |
| NPI Number: | 1255672564 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MHP |
| License Number: | |
| Business Practice Address: | 206 W 5th St Apt. D Metropolis, IL - 629601810 |
| Business Phone Number: | 6185249368 |
| Business Fax Number: | 6185249551 |
| Mailing Address: | 306 W 8th St Apt D, METROPOLIS |
| State: | IL |
| Postal Code: | 629601656 |
| Phone Number: | 6185243653 |
| Fax Number: | 6185244769 |
| NPI Enumeration Date: | 03/12/2013 |
| NPI Last Update Date: | 03/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |