Individual
MRS. SHANNON L SEYEDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LISAC
Contact information
Practice address
2722 S 186TH DR, GOODYEAR, AZ 85338-4216
(480) 650-6242
Mailing address
2722 S 186TH DR, GOODYEAR, AZ 85338-4216
(480) 650-6242
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-10312
AZ
1041C0700X
Clinical Social Worker
Primary
LCSW-10573
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
761412
PROVIDER NUMBER
AZ
Enumeration date
03/13/2007
Last updated
08/30/2023
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