Otto, Shannon Joel

Otto, Shannon Joel is an sole proprietor health care provider with primary practice located at 220 4Th Ave , Raton NM 87740-2643. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / School, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Otto, Shannon Joel can be contacted via phone (575) 445-2754.

Contact Information

Primary practice address
220 4Th Ave Raton NM 87740-2643
Phone: (575) 445-2754
Fax: (575) 445-2225
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 1041S0200X 313365 New Mexico
Behavioral Health & Social Service Providers / Clinical 1041C0700X M-05899 New Mexico

Profile Details

NPI number 1114049673
LBN Legal business name Otto, Shannon Joel
Credentials LMSW
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 4th, 2007
Last updated Nov 12th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114049673 NPPES
New Mexico MEDICAID 13829068

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