Provider Demographics
NPI:1063638302
Name:SKINNER, CHRISTOPHER SHAWN (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SHAWN
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 69 BOX 1455
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:MO
Mailing Address - Zip Code:63650-9606
Mailing Address - Country:US
Mailing Address - Phone:573-546-2758
Mailing Address - Fax:573-546-0125
Practice Address - Street 1:HC 69 BOX 1455
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-9606
Practice Address - Country:US
Practice Address - Phone:573-546-2758
Practice Address - Fax:573-546-0125
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001022080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCABCOR9COLCON1Medicaid