Provider Demographics
NPI:1699328757
Name:SMITH, SHANNON DEE (LMHC)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:DEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 N COUNTY ROAD 1000 E
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:IN
Mailing Address - Zip Code:47246-9665
Mailing Address - Country:US
Mailing Address - Phone:812-614-2468
Mailing Address - Fax:
Practice Address - Street 1:1531 13TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1300
Practice Address - Country:US
Practice Address - Phone:812-343-4731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty