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1699874198
KELLY SHANNON
SAN ANTONIO, TX
NPI
1699874198
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: TX 2-3034)
Enumeration Date
2006-09-21
Last Update Date
2009-03-24
Business Address
-- KELLY SHANNON PhD
102 E MULBERRY AVE
SAN ANTONIO, TX 78212-2946
Phone number: 210-279-1516
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Mailing Address
-- KELLY SHANNON PhD
PO BOX 120041
SAN ANTONIO, TX 78212-9241
Phone number: 210-279-1516
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