Provider Demographics
NPI:1013639103
Name:PROBASCO, SHANNON N (PLPC, LCMHC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:N
Last Name:PROBASCO
Suffix:
Gender:F
Credentials:PLPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2505
Mailing Address - Country:US
Mailing Address - Phone:198-563-0748
Mailing Address - Fax:
Practice Address - Street 1:4035 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-2935
Practice Address - Country:US
Practice Address - Phone:504-358-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
LAPLC9324101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator