Provider Demographics
NPI:1962111401
Name:SHANNON SHEATS LLC
Entity type:Organization
Organization Name:SHANNON SHEATS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-631-8634
Mailing Address - Street 1:328 S CENTRAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7274
Mailing Address - Country:US
Mailing Address - Phone:541-500-8195
Mailing Address - Fax:540-500-8196
Practice Address - Street 1:328 S CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7274
Practice Address - Country:US
Practice Address - Phone:541-500-8195
Practice Address - Fax:540-500-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty