Provider Demographics
NPI:1023331311
Name:GUIDRY, SHANNON PAUL (MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:PAUL
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 S KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-9166
Mailing Address - Country:US
Mailing Address - Phone:559-970-9592
Mailing Address - Fax:559-314-6099
Practice Address - Street 1:276 S KENNETH AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-9166
Practice Address - Country:US
Practice Address - Phone:559-970-9592
Practice Address - Fax:559-314-6099
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist