Provider Demographics
NPI:1134519853
Name:PLATE, SHANNON LYNNE (LCPLC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LYNNE
Last Name:PLATE
Suffix:
Gender:F
Credentials:LCPLC
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:LYNNE
Other - Last Name:WOOLFITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:616 N NORTH CT
Mailing Address - Street 2:ST. 100
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8156
Mailing Address - Country:US
Mailing Address - Phone:847-567-0173
Mailing Address - Fax:
Practice Address - Street 1:616 N NORTH CT
Practice Address - Street 2:ST. 100
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8156
Practice Address - Country:US
Practice Address - Phone:847-567-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health