Provider Demographics
NPI:1659193266
Name:CARNAL, SHANNON (PLPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CARNAL
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ERIN RD
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-7319
Mailing Address - Country:US
Mailing Address - Phone:573-259-6830
Mailing Address - Fax:
Practice Address - Street 1:625 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-1537
Practice Address - Country:US
Practice Address - Phone:573-259-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024034629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health