Provider Demographics
NPI:1598180861
Name:NELSON, SHANNON K (MS, LMFT, CCLS, PLLC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:K
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, LMFT, CCLS, PLLC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MONNIG
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT, CCLS, PLLC
Mailing Address - Street 1:6322 SOVEREIGN ST STE 263
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5188
Mailing Address - Country:US
Mailing Address - Phone:210-317-2515
Mailing Address - Fax:
Practice Address - Street 1:6322 SOVEREIGN ST
Practice Address - Street 2:BLDG 1 STE 263
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5142
Practice Address - Country:US
Practice Address - Phone:210-317-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2020-06-04
Deactivation Date:2020-05-12
Deactivation Code:
Reactivation Date:2020-05-20
Provider Licenses
StateLicense IDTaxonomies
TX201450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist