Provider Demographics
NPI:1548343569
Name:BROWN, SHANNON (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 DEER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1707
Mailing Address - Country:US
Mailing Address - Phone:972-880-1722
Mailing Address - Fax:214-295-8888
Practice Address - Street 1:1506 N GREENVILLE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8622
Practice Address - Country:US
Practice Address - Phone:972-880-1722
Practice Address - Fax:214-295-8888
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83851LOtherBLUE CROSS/BLUE SHIELD