Provider Demographics
NPI:1558253658
Name:PASCHALL, SHANNON (LAC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PASCHALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 W SIENNA BOUQUET PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8042
Mailing Address - Country:US
Mailing Address - Phone:480-640-7988
Mailing Address - Fax:480-546-3728
Practice Address - Street 1:1904 W PARKSIDE LN STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1232
Practice Address - Country:US
Practice Address - Phone:480-798-2050
Practice Address - Fax:480-546-3728
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health