Provider Demographics
NPI:1053003848
Name:TAPP, SHANNON (LPES)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:TAPP
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HUNGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10070 DORCHESTER RD UNIT 50017
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-2507
Mailing Address - Country:US
Mailing Address - Phone:843-376-3112
Mailing Address - Fax:843-594-0110
Practice Address - Street 1:1815 BACONS BRIDGE RD APT B12
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-3258
Practice Address - Country:US
Practice Address - Phone:843-376-3112
Practice Address - Fax:843-594-0110
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4650103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool