Provider Demographics
NPI:1144714585
Name:LARANCE, SHANNON (LCSWA)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:LARANCE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E BELL RD STE 2-132
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2383
Mailing Address - Country:US
Mailing Address - Phone:602-405-2261
Mailing Address - Fax:
Practice Address - Street 1:1949 W CHISUM TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8657
Practice Address - Country:US
Practice Address - Phone:602-405-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0123751041C0700X
AZLCSW-20062101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical