Provider Demographics
NPI:1891501797
Name:VIOLA, SHANNON BEASON (PHD, LSSP, LP)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:BEASON
Last Name:VIOLA
Suffix:
Gender:F
Credentials:PHD, LSSP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17531 DRIFTWOOD PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5122
Mailing Address - Country:US
Mailing Address - Phone:620-249-1606
Mailing Address - Fax:
Practice Address - Street 1:2815 ROSEFIELD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-2605
Practice Address - Country:US
Practice Address - Phone:713-479-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34981103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist