Provider Demographics
NPI:1871319525
Name:HILLIBUSH, SHANNON (MPA, MA, PPC, NCCC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HILLIBUSH
Suffix:
Gender:F
Credentials:MPA, MA, PPC, NCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6164 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4310
Mailing Address - Country:US
Mailing Address - Phone:307-267-5255
Mailing Address - Fax:
Practice Address - Street 1:701 ANTLER DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1726
Practice Address - Country:US
Practice Address - Phone:307-374-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health