Provider Demographics
NPI:1053970707
Name:MARSHALL, SHAWNA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 OAK DR
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-1791
Mailing Address - Country:US
Mailing Address - Phone:507-920-3441
Mailing Address - Fax:
Practice Address - Street 1:118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1829
Practice Address - Country:US
Practice Address - Phone:507-449-6105
Practice Address - Fax:507-449-6106
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional