Individual
MELANIE R SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6900 HOUSTON RD STE 12, FLORENCE, KY 41042-4891
(310) 619-8989
Mailing address
434 SCOTT ST, COVINGTON, KY 41011-2342
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
259926
KY
101YP2500X
Professional Counselor
Primary
259926
KY
101YP2500X
Professional Counselor
C.1700453
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
259926
LICENSURE
KY
01
—
C.1700453
LICENSURE
OH
Enumeration date
10/12/2017
Last updated
01/31/2024
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