Provider Demographics
NPI:1982111654
Name:HUNTSBERRY, SHANNON (MA, LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HUNTSBERRY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:899 HWY 287 STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7319
Mailing Address - Country:US
Mailing Address - Phone:303-443-8500
Mailing Address - Fax:
Practice Address - Street 1:899 HWY 287 STE 300
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7319
Practice Address - Country:US
Practice Address - Phone:303-443-8500
Practice Address - Fax:303-464-1413
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional