Provider Demographics
NPI:1699273888
Name:PINEAU, SHANNON MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:PINEAU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 AVENUE E E
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3606
Mailing Address - Country:US
Mailing Address - Phone:269-491-1741
Mailing Address - Fax:720-306-5325
Practice Address - Street 1:949 AVENUE E E
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3606
Practice Address - Country:US
Practice Address - Phone:269-491-1741
Practice Address - Fax:720-306-5325
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015042101Y00000X
MI6401015397101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor