Provider Demographics
NPI:1164571006
Name:GILBERT, SHAUNA CLARK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:CLARK
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAKE SAINT LOUIS BLVD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1340
Mailing Address - Country:US
Mailing Address - Phone:636-265-1004
Mailing Address - Fax:636-265-1005
Practice Address - Street 1:1000 LAKE SAINT LOUIS BLVD
Practice Address - Street 2:SUITE 222
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1340
Practice Address - Country:US
Practice Address - Phone:636-265-1004
Practice Address - Fax:636-265-1005
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4552101YM0800X
MO20120101061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health