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

Shannon Bruckbauer

Individual provider Mental Health Counselor · NPI 1972295947

Shannon Bruckbauer is a Mental Health Counselor in South Lake Tahoe, California. Licensed in California. Registered with an NPI since 2023.

Licensed in
CA
In the registry since
2023

Practice location Address checks out

1900 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6305
Phone: (530) 573-7970
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 9065 (CA)

Record details

NPI number1972295947
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 25, 2023
Last updated in NPPESMay 25, 2023
Certification dateMay 25, 2023

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