Provider Demographics
NPI:1265325013
Name:GARCIA, SHANNON DAWNEL
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DAWNEL
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:GARCIA
Other - Last Name:SHINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6835 N WALL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5631
Mailing Address - Country:US
Mailing Address - Phone:971-570-4825
Mailing Address - Fax:
Practice Address - Street 1:239 NE LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3066
Practice Address - Country:US
Practice Address - Phone:971-238-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-QMHP-R-3596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health