Provider Demographics
NPI:1447094354
Name:STONE, SHANNA (LAC)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 S WAKIAL LOOP APT 3110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5035
Mailing Address - Country:US
Mailing Address - Phone:480-714-4898
Mailing Address - Fax:
Practice Address - Street 1:13201 S WAKIAL LOOP APT 3110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5035
Practice Address - Country:US
Practice Address - Phone:480-714-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-19102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health