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1407001258
CARLY BLAKE SHANNON
AUSTIN, TX
NPI
1407001258
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: TX 62456)
Enumeration Date
2008-11-20
Last Update Date
2008-11-20
Business Address
Ms. CARLY BLAKE SHANNON LPC
1433 FAIRFIELD DR
AUSTIN, TX 78758-7244
Phone number: 512-491-8444
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Mailing Address
Ms. CARLY BLAKE SHANNON LPC
1433 FAIRFIELD DR
AUSTIN, TX 78758-7244
Phone number: 512-491-8444
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