Doctor Name: | SHANNON LYNN MONGALISE |
NPI Number: | 1285990630 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | PC005963 |
Business Practice Address: | 243 Johnston Rd Upper Saint Clair, PA - 152412534 |
Business Phone Number: | 4124699771 |
Business Fax Number: | |
Mailing Address: | 1331 Quail Run Cir, BETHEL PARK |
State: | PA |
Postal Code: | 151023143 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/10/2012 |
NPI Last Update Date: | 03/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | PC005963 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |