Provider Demographics
NPI:1124402789
Name:WILLIAMS, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:WILLIAMS-PRATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:3495 RAUSCHER DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3832
Mailing Address - Country:US
Mailing Address - Phone:775-691-1752
Mailing Address - Fax:
Practice Address - Street 1:3495 RAUSCHER DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3832
Practice Address - Country:US
Practice Address - Phone:775-691-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075363101YM0800X
WI6224-125101YP2500X
NVCP5046-R101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health