Provider Demographics
NPI:1336461573
Name:DINNING, SHANNON MICHELE (MA, LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELE
Last Name:DINNING
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2819
Mailing Address - Country:US
Mailing Address - Phone:520-670-3909
Mailing Address - Fax:520-309-2560
Practice Address - Street 1:3950 S COUNTRY CLUB RD STE 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-2203
Practice Address - Country:US
Practice Address - Phone:520-670-3909
Practice Address - Fax:520-309-2560
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
322D00000X, 385H00000X, 324500000X, 385HR2055X, 253Z00000X, 320800000X
AZLPC-13319101YP2500X
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385H00000XRespite Care FacilityRespite Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No253Z00000XAgenciesIn Home Supportive Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ324615Medicaid