Provider Demographics
NPI:1528305174
Name:KEY, SHANNON M (LPC, NCC)
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:M
Last Name:KEY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-5143
Mailing Address - Country:US
Mailing Address - Phone:815-519-2195
Mailing Address - Fax:
Practice Address - Street 1:11415 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9500
Practice Address - Country:US
Practice Address - Phone:815-519-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008758101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional