Provider Demographics
NPI:1518239128
Name:LOUNSBERY, WILLIAM SHANE (LMSW, IADC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SHANE
Last Name:LOUNSBERY
Suffix:
Gender:M
Credentials:LMSW, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 E 38TH STREET
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317
Mailing Address - Country:US
Mailing Address - Phone:515-451-1072
Mailing Address - Fax:
Practice Address - Street 1:2824 E 38TH STREET
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317
Practice Address - Country:US
Practice Address - Phone:515-451-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11055101YA0400X
IA006858104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker