Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1104485598 |
---|---|
Provider Name | Dr. Brittany Jordan Shannon |
First Address | Oxford, OH 45056-9723 |
Second Address | Lexington, KY 40511-1052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 10/06/2019 |