Provider Demographics
NPI:1104103332
Name:GILLAND, SHANNON M
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:GILLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 APRIL BREEZE LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9359
Mailing Address - Country:US
Mailing Address - Phone:702-581-5357
Mailing Address - Fax:
Practice Address - Street 1:2470 SAINT ROSE PKWY STE 302
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7776
Practice Address - Country:US
Practice Address - Phone:702-808-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV26-4620648261QM0801X
NVCI5097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)