Provider Demographics
NPI:1063202430
Name:LIM, SHANN LOUIS
Entity type:Individual
Prefix:
First Name:SHANN LOUIS
Middle Name:
Last Name:LIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 RANCH VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5357
Mailing Address - Country:US
Mailing Address - Phone:805-407-6192
Mailing Address - Fax:
Practice Address - Street 1:8303 SIERRA COLLEGE BLVD STE 146
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95661-9419
Practice Address - Country:US
Practice Address - Phone:916-746-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC16961101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor