Provider Demographics
NPI:1679775985
Name:EDWARDS, SHANNON NICOLE (MFT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 16TH AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2025
Mailing Address - Country:US
Mailing Address - Phone:415-505-3374
Mailing Address - Fax:
Practice Address - Street 1:1259 16TH AVE
Practice Address - Street 2:APT 3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2025
Practice Address - Country:US
Practice Address - Phone:415-505-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist