| Patrick Shannon, Lcsw, Pllc | |
|
3700 S Russell St Ste B110 Missoula MT 59801-8574 | |
| (406) 763-6611 | |
| Not Available |
| Full Name | Patrick Shannon, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 3700 S Russell St Ste B110, Missoula, Montana |
| Authorized Official Name and Position | Patrick Shannon (THERAPIST/OWNER) |
| Authorized Official Contact | 4067636611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Patrick Shannon, Lcsw, Pllc Po Box 801 Missoula MT 59806-0801 Ph: (406) 763-6611 | Patrick Shannon, Lcsw, Pllc 3700 S Russell St Ste B110 Missoula MT 59801-8574 Ph: (406) 763-6611 |
| NPI Number | 1619644929 |
|---|---|
| Provider Enumeration Date | 08/24/2021 |
| Last Update Date | 12/29/2021 |
| Certification Date | 12/29/2021 |
| Medicare PECOS PAC ID | 1951708551 |
|---|---|
| Medicare Enrollment ID | O20210924000167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619644929 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Patrick Shannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326633207 PECOS PAC ID: 9830596410 Enrollment ID: I20210923003330 |
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