Individual
DR. SHANNON L BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
6120 HAVELOCK AVE, SUITE B, LINCOLN, NE 68507-1278
(402) 432-0745
Mailing address
4949 ASHLAND ROAD, PO BOX 533, CERESCO, NE 68017
(402) 432-0745
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
422
NE
Other
Enumeration date
07/24/2006
Last updated
07/08/2007
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