Provider Demographics
NPI:1932957446
Name:SHANNON OTTO COUNSELING, LLC
Entity type:Organization
Organization Name:SHANNON OTTO COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-582-6562
Mailing Address - Street 1:13 RICCARDI DR
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2747
Mailing Address - Country:US
Mailing Address - Phone:570-861-6188
Mailing Address - Fax:
Practice Address - Street 1:13 RICCARDI DR
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-2747
Practice Address - Country:US
Practice Address - Phone:570-861-6188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty