Provider Demographics
NPI:1720605140
Name:O'CONNOR, SHANNON D (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14402 SHAVANO HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1449
Mailing Address - Country:US
Mailing Address - Phone:801-558-9256
Mailing Address - Fax:
Practice Address - Street 1:14402 SHAVANO HL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1449
Practice Address - Country:US
Practice Address - Phone:801-558-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX96115OtherLPC-ASSOCIATE