Shannon Theobald, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00896500 Issued in NJ

Practice address

181 New Rd Ste 304
Parsippany, NJ 07054-5625

Phone

(201) 389-9308

NPI assigned

Aug 6, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1669146205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 LAKE AVE",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051135",
            "telephone_number": "201-407-7047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 NEW RD STE 304",
            "city": "PARSIPPANY",
            "state": "NJ",
            "postal_code": "070545625",
            "telephone_number": "201-389-9308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Lake Ave",
            "address_purpose": "LOCATION",
            "city": "Boonton",
            "state": "NJ",
            "postal_code": "070051135",
            "country_code": "US",
            "telephone_number": "201-407-7047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "SHANNON",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-06",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00896500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Parsippany, NJ
• Providers in Parsippany, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.