Provider Demographics
NPI:1174898670
Name:ROUX (DBA SHANNON SPRUNG MA LMHC), SHANNON LEA (LMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEA
Last Name:ROUX (DBA SHANNON SPRUNG MA LMHC)
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 SW ALASKA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4453
Mailing Address - Country:US
Mailing Address - Phone:512-554-2402
Mailing Address - Fax:
Practice Address - Street 1:4302 SW ALASKA ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4453
Practice Address - Country:US
Practice Address - Phone:512-554-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11941101YM0800X
TX66216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health