Provider Demographics
NPI:1750094587
Name:WASHINGTON, SHANNON (MA, PLPC, NCC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MA, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 BOXWOOD DR APT 1
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4166
Mailing Address - Country:US
Mailing Address - Phone:314-765-5190
Mailing Address - Fax:
Practice Address - Street 1:339 BROADWAY ST STE 102
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-7321
Practice Address - Country:US
Practice Address - Phone:573-271-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022049351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health