Individual
SHANNON JANELLE LIEBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
754 NW BROADWAY ST STE 207, BEND, OR 97703-2776
(541) 668-7558
Mailing address
19748 DRY CANYON AVE, BEND, OR 97702-3961
(619) 246-5206
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
R9433
OR
101YP2500X
Professional Counselor
R9433
OR
Other
Enumeration date
07/02/2024
Last updated
12/07/2024
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