Provider Demographics
NPI:1174152623
Name:JONES, SHANNON MARIE (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:JONES
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 1:1118 F ST # B
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1986
Mailing Address - Country:US
Mailing Address - Phone:298-799-4440
Mailing Address - Fax:208-799-5171
Practice Address - Street 1:1118 F ST # B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1930
Practice Address - Country:US
Practice Address - Phone:208-799-4440
Practice Address - Fax:208-799-5171
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional