Provider Demographics
NPI:1972890515
Name:RUDY, SHANNON LEE (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEE
Last Name:RUDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SANDY HOLLOW RD
Mailing Address - Street 2:TRUE
Mailing Address - City:SHERMANS DALE
Mailing Address - State:PA
Mailing Address - Zip Code:17090-8034
Mailing Address - Country:US
Mailing Address - Phone:814-442-9526
Mailing Address - Fax:
Practice Address - Street 1:1 GREYSTONE RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2660
Practice Address - Country:US
Practice Address - Phone:717-249-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional