Provider Demographics
NPI:1669620274
Name:KHAN, SHANNON H (MA, LPC, LPA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:H
Last Name:KHAN
Suffix:
Gender:F
Credentials:MA, LPC, LPA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:H
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, LPA
Mailing Address - Street 1:3701 KIRBY DR., SUITE 1014
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098
Mailing Address - Country:US
Mailing Address - Phone:832-243-2381
Mailing Address - Fax:832-203-4077
Practice Address - Street 1:3701 KIRBY DR.
Practice Address - Street 2:SUITE 1014
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098
Practice Address - Country:US
Practice Address - Phone:832-243-2381
Practice Address - Fax:832-203-4077
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194737301Medicaid