Provider Demographics
NPI:1043058787
Name:JASSO, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:JASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12516 ROBERT DAVID DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-1756
Mailing Address - Country:US
Mailing Address - Phone:915-588-9233
Mailing Address - Fax:
Practice Address - Street 1:1780 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-1229
Practice Address - Country:US
Practice Address - Phone:575-646-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor