Individual
AMANDA SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
506 GROVER ST STE 112, LYNDEN, WA 98264
(360) 383-8682
(360) 255-0439
Mailing address
506 GROVER ST STE 112, LYNDEN, WA 98264-1960
(360) 383-8682
(360) 255-0439
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
61542
CA
101YM0800X
Mental Health Counselor
MG 60146874
WA
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00007301
—
CA
Enumeration date
01/20/2010
Last updated
08/06/2019
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