Doctor Name: | MS. TERESA Z SHANNON |
NPI Number: | 1538120852 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH7036 |
Business Practice Address: | 1332 Deerpath Rd Chipley, FL - 324285847 |
Business Phone Number: | 8505737747 |
Business Fax Number: | |
Mailing Address: | 1332 Deerpath Rd, CHIPLEY |
State: | FL |
Postal Code: | 324285847 |
Phone Number: | 8505737747 |
Fax Number: | |
NPI Enumeration Date: | 03/28/2006 |
NPI Last Update Date: | 06/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH7036 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |