Provider Demographics
NPI:1386625648
Name:SHANNON WOOD WILLIAMS LMFT, INC
Entity type:Organization
Organization Name:SHANNON WOOD WILLIAMS LMFT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:WOOD-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:850-769-3756
Mailing Address - Street 1:730 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2436
Mailing Address - Country:US
Mailing Address - Phone:850-769-3756
Mailing Address - Fax:850-769-3757
Practice Address - Street 1:730 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2436
Practice Address - Country:US
Practice Address - Phone:850-769-3756
Practice Address - Fax:850-769-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0001097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT0001097OtherLICENSE NUMBER