Provider Demographics
NPI:1023710993
Name:RODRIGUE, SHANNON (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RODRIGUE
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 1:200 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6525
Mailing Address - Country:US
Mailing Address - Phone:573-449-3953
Mailing Address - Fax:
Practice Address - Street 1:200 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6525
Practice Address - Country:US
Practice Address - Phone:573-449-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88083101YP2500X
MO2025010376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional