Peck, Shannon Burton

Peck, Shannon Burton is an individual health care provider with primary practice located at 510 E Stoner Ave , Shreveport LA 71101-4243. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Peck, Shannon Burton can be contacted via phone (318) 990-4957.

Contact Information

Primary practice address
510 E Stoner Ave Shreveport LA 71101-4243
Phone: (318) 990-4957
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 32882 Texas

Profile Details

NPI number 1902963929
LBN Legal business name Peck, Shannon Burton
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 2nd, 2007
Last updated Aug 2nd, 2013 - about 13 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 1902963929 NPPES
Texas MEDICAID 177186701

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