Provider Demographics
NPI:1053486340
Name:MOYER, SHANNON KAY (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KAY
Last Name:MOYER
Suffix:
Gender:
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:KAY
Other - Last Name:STRUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:635 N 12TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1225
Mailing Address - Country:US
Mailing Address - Phone:717-412-0245
Mailing Address - Fax:
Practice Address - Street 1:635 N 12TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1225
Practice Address - Country:US
Practice Address - Phone:717-412-0245
Practice Address - Fax:717-510-6704
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist