| NPI | 1467003350 |
|---|---|
| Former Name | SHANNA MARIE TIPTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0015265) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 68303) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2025-01-14 |