Provider Demographics
NPI:1326376260
Name:LEE, SHAWN PHILLIP (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PHILLIP
Last Name:LEE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3512
Mailing Address - Country:US
Mailing Address - Phone:573-760-1365
Mailing Address - Fax:573-760-0354
Practice Address - Street 1:1580 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3512
Practice Address - Country:US
Practice Address - Phone:573-760-1365
Practice Address - Fax:573-760-0354
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110381081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical