Provider Demographics
NPI:1881104966
Name:O'NEILL, SHANNON E (LMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CALLE CUERVO NW APT 1117
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-9218
Mailing Address - Country:US
Mailing Address - Phone:505-644-2069
Mailing Address - Fax:
Practice Address - Street 1:3505 CALLE CUERVO NW APT 1117
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-9218
Practice Address - Country:US
Practice Address - Phone:505-644-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NMCTB20220935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician