Provider Demographics
NPI:1871937920
Name:BISSON, SHAUNA L (LPC)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:L
Last Name:BISSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CAPITAL BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3914
Mailing Address - Country:US
Mailing Address - Phone:860-919-0362
Mailing Address - Fax:
Practice Address - Street 1:175 CAPITAL BLVD STE 402
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3914
Practice Address - Country:US
Practice Address - Phone:860-919-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health