Individual
MRS. SHANNON NICOLE FARROUGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A, LPC
Contact information
Practice address
5520 SW MACADAM, AVE, SUITE 270, PORTLAND, OR 97239
(503) 888-1369
(503) 646-8401
Mailing address
5520 SW MACADAM, AVE, SUITE 270, PORTLAND, OR 97239
(503) 888-1369
(503) 646-8401
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C3859
OR
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
C3859
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000WDBCH
GROUP MEDICARE
OR
01
—
0000WDBCH
GROUP MEDICARE
WA
05
—
164936
—
OR
Enumeration date
10/15/2012
Last updated
02/19/2019
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