Basic Information
| Provider Information | |||||||||
| NPI: | 1295036085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS ROMERO | ||||||||
| FirstName: | SHANNA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 RAILROAD ST W | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062584789 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 401 RAILROAD ST W | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062584789 | ||||||||
| FaxNumber: | 4062584732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2010 | ||||||||
| LastUpdateDate: | 09/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 24733 | MT | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 38670 | MT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.