Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 80382 | TX |
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | 80382 | TX |
NPI | 1205487048 |
---|---|
Provider Name | Mr. Shanon Thomas |
First Address | Rockwall, TX 75032-6861 |
Second Address | Rockwall, TX 75087-4250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2019 |
Last Update Date | 14/04/2021 |