Provider Demographics
NPI:1487046801
Name:KERNS, SHANNON (MS; LBS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KERNS
Suffix:
Gender:F
Credentials:MS; LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 FREEDOM WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9282
Mailing Address - Country:US
Mailing Address - Phone:717-600-0900
Mailing Address - Fax:
Practice Address - Street 1:2351 FREEDOM WAY STE 200
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9282
Practice Address - Country:US
Practice Address - Phone:717-600-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-22
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001008101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor