Provider Demographics
NPI:1124262373
Name:THOMAS, SHANNON (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 E SOUTHLAKE BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6286
Mailing Address - Country:US
Mailing Address - Phone:817-897-8882
Mailing Address - Fax:817-953-8900
Practice Address - Street 1:231 E SOUTHLAKE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6286
Practice Address - Country:US
Practice Address - Phone:817-897-8882
Practice Address - Fax:817-953-8900
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX503251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical