Provider Demographics
NPI:1871303826
Name:VESTER, SHANNAN M (MA, LPC)
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:M
Last Name:VESTER
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 EIDER LN
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1515
Mailing Address - Country:US
Mailing Address - Phone:586-536-2090
Mailing Address - Fax:
Practice Address - Street 1:31 EIDER LN
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1515
Practice Address - Country:US
Practice Address - Phone:248-923-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7957101YM0800X
MI6401019060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health