Provider Demographics
NPI:1225076623
Name:MORFELD, SHANNON N CARPENTER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:N CARPENTER
Last Name:MORFELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:N
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 COUNTY ROAD 612
Mailing Address - Street 2:
Mailing Address - City:FREEBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65035-2366
Mailing Address - Country:US
Mailing Address - Phone:573-291-8821
Mailing Address - Fax:
Practice Address - Street 1:1432 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109
Practice Address - Country:US
Practice Address - Phone:573-632-5560
Practice Address - Fax:573-632-5875
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO732280OtherHEALTHLINK
MO202601OtherBCBS