Provider Demographics
NPI:1306985023
Name:WENGER, SHANNON PAIGE (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:PAIGE
Last Name:WENGER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:BINKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18333 EGRET BAY BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058
Mailing Address - Country:US
Mailing Address - Phone:281-333-5740
Mailing Address - Fax:281-333-4013
Practice Address - Street 1:18333 EGRET BAY BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-333-5740
Practice Address - Fax:281-333-4013
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154770501Medicaid
C14769Medicare UPIN