| Shannon L Deitch | |
|
105 N Gordon St Ste 202 Alvin TX 77511-2373 | |
| (346) 774-1774 | |
| (281) 585-0080 |
| Full Name | Shannon L Deitch |
|---|---|
| Speciality | Counselor |
| Location | 105 N Gordon St Ste 202, Alvin, Texas |
| Authorized Official Name and Position | Shannon Deitch (OWNER) |
| Authorized Official Contact | 3467741774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon L Deitch 105 N Gordon St Ste 202 Alvin TX 77511-2373 Ph: (346) 774-1774 | Shannon L Deitch 105 N Gordon St Ste 202 Alvin TX 77511-2373 Ph: (346) 774-1774 |
| NPI Number | 1568018349 |
|---|---|
| Provider Enumeration Date | 08/16/2019 |
| Last Update Date | 01/24/2024 |
| Certification Date | 01/24/2024 |
| Medicare PECOS PAC ID | 7214372804 |
|---|---|
| Medicare Enrollment ID | O20240305003898 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568018349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Shannon L Deitch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639592843 PECOS PAC ID: 8123463718 Enrollment ID: I20240306003052 |
| Provider Name | Kelli Pinac Nickel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144754466 PECOS PAC ID: 4688015449 Enrollment ID: I20240510000012 |
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