Individual
SHANNON KILLPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
4641 N 12TH ST, PHOENIX, AZ 85014-4095
(505) 681-9581
Mailing address
4535 N 129TH DR, LITCHFIELD PARK, AZ 85340-5126
(505) 681-9581
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-21924
AZ
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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