Shannon, Kelly

Shannon, Kelly is an sole proprietor health care provider with primary practice located at 102 E Mulberry Ave , San Antonio TX 78212-2946. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Shannon, Kelly can be contacted via phone (210) 279-1516.

Contact Information

Primary practice address
102 E Mulberry Ave San Antonio TX 78212-2946
Phone: (210) 279-1516
Fax: (210) 733-0141
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2-3034 Texas

Profile Details

NPI number 1699874198
LBN Legal business name Shannon, Kelly
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 21st, 2006
Last updated Mar 24th, 2009 - about 16 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 1699874198 NPPES
Texas Other H00088RY01 BCBS - TX
Texas MEDICAID 035931704 BCBS - TX

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