Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Shannon, PHD

Individual provider Clinical Psychologist · NPI 1699874198

Kelly Shannon, PHD is a Clinical Psychologist in San Antonio, Texas. Qualified in 1979, 47 years ago. Practices as a sole proprietor. Licensed in Texas.

Years since qualifying
47
Licensed in
TX
In the registry since
2006
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

102 E Mulberry Ave
San Antonio, TX 78212-2946
Phone: (210) 279-1516
Fax: (210) 733-0141
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 2-3034 (TX)

Record details

NPI number1699874198
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedSeptember 21, 2006
Last updated in NPPESMarch 24, 2009

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 1979 (47 years in practice)
Accepts Medicare assignment Not indicated

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