Individual
SHANNON IVY HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
355 W 16TH ST, STE 2500, INDIANAPOLIS, IN 46202-2280
(317) 963-7204
(317) 963-7211
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
20043698A
IN
103TC0700X
Clinical Psychologist
20043698A
IN
103TH0100X
Health Service Psychologist
20043698B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104565401
ANTHEM PTAN
IN
05
—
300098450
—
IN
Enumeration date
10/02/2024
Last updated
02/11/2025
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