Provider Demographics
NPI:1508016932
Name:DURHAM, SHANNON KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAY
Last Name:DURHAM
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 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8186
Mailing Address - Fax:
Practice Address - Street 1:1620 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3057
Practice Address - Country:US
Practice Address - Phone:660-428-1280
Practice Address - Fax:660-428-1283
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080098721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical