Shannon Lea Peck, MS LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

13772 Issued in TX

Practice address

3030 Nacogdoches Rd Ste 101
San Antonio, TX 78217-4502

Phone

(210) 826-9599

Fax

(210) 826-9828

NPI assigned

Aug 21, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Ms. Shannon Lea Peck Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1457466922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5410 FREDERICKSBURG ROAD",
            "address_2": "SUITE 111",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293539",
            "telephone_number": "210-524-9402",
            "fax_number": "210-524-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 NACOGDOCHES RD STE 101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782174502",
            "telephone_number": "210-826-9599",
            "fax_number": "210-826-9828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "SHANNON",
        "middle_name": "LEA",
        "name_prefix": "Mrs.",
        "credential": "MS LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "13772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "A046244",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3479LC",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027879801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "PECK",
            "middle_name": "LEA",
            "prefix": "MS.",
            "credential": "MS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Rosauro Peciller Jr., D.P.T.
• Brandon Lee Peck, PTA
• Cristobal Peck II
• Jennifer Kristin Peck, OTR
• Michael Peck, M.D.
• Steven James Peckham, MD
• Kim Peden
• Robert McNeely Peden, LPC
• Annette Johanna Pedersen, LPC
• Craig Steven Pedersen, D.O.

• Professional Counselor in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.