Provider Demographics
NPI:1720886955
Name:LEE, SHANNON (MA, LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:MA, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 ROUND TABLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2827
Mailing Address - Country:US
Mailing Address - Phone:210-420-8094
Mailing Address - Fax:
Practice Address - Street 1:5255 ROUND TABLE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-2827
Practice Address - Country:US
Practice Address - Phone:210-420-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health