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SHANNON BRUCKBAUER
NPI 1972295947
Counselor - Mental Health in South Lake Tahoe, CA

Active since May 25, 2023
1900 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150(530) 573-7970 Get Directions Write a Review

NPPES record last updated: May 25, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shannon Bruckbauer NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANNON BRUCKBAUER (NPI 1972295947) is an individual mental health provider in South Lake Tahoe, California, licensed in California (9065) and active in the NPI registry since May 2023.

NPPES Registry Identity

NPI1972295947
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameSHANNON BRUCKBAUER
Location Address1900 LAKE TAHOE BLVDSouth Lake Tahoe, CA 96150-6305
Mailing Address1900 Lake Tahoe BlvdSouth Lake Tahoe, CA 96150-6305
Phone(530) 573-7970
Sole ProprietorNo
Enumeration DateMay 25, 2023
NPPES CertifiedMay 25, 2023
✔ NPI 1972295947 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in CA · 9065
1900 LAKE TAHOE BLVD, South Lake Tahoe, CA 96150
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASHLEY MARIE MAVON
Case Manager/Care Coordinator
1900 LAKE TAHOE BLVD
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 573-7927
JASON EDWARD MOORE
Case Manager/Care Coordinator
1900 LAKE TAHOE BLVD
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 573-7970
DR. JUANITA LERMA HERNANDEZ-MORIN PSY.D.
Psychologist (Clinical)
1900 LAKE TAHOE BLVD
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 573-7993
COUNTY OF EL DORADO
Community/Behavioral Health
1900 LAKE TAHOE BLVD
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 621-6207
SHERESE CHRETIEN
Psychologist
1900 LAKE TAHOE BLVD
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 573-7909
ELIZABETH DRABANT
Social Worker (Clinical)
1900 LAKE TAHOE BLVD
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 573-7970
SHEREE SMAIL
Case Manager/Care Coordinator
1900 LAKE TAHOE BLVD
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 573-7861
SUSAN ARIANA TARISA BENHAM
Social Worker
1900 LAKE TAHOE BLVD
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 318-4824

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shannon Bruckbauer's NPI number?

The NPI number for Shannon Bruckbauer is 1972295947. It was assigned to this individual provider in the NPPES registry on May 25, 2023.

Where is Shannon Bruckbauer located?

Shannon Bruckbauer practices at 1900 Lake Tahoe Blvd, South Lake Tahoe, CA 96150. The listed phone number is (530) 573-7970.

What is Shannon Bruckbauer's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Shannon Bruckbauer was last updated on May 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.