Provider Demographics
NPI:1063127587
Name:SHANNON, KARA (LMFT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:IRONSIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7464 E TIERRA BUENA LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1643
Mailing Address - Country:US
Mailing Address - Phone:602-492-4174
Mailing Address - Fax:
Practice Address - Street 1:7464 E TIERRA BUENA LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1643
Practice Address - Country:US
Practice Address - Phone:602-492-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist