Provider Demographics
NPI:1578666558
Name:SHYNE, MO ANNE (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:MO
Middle Name:ANNE
Last Name:SHYNE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAIN ST STE 203C
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3173
Mailing Address - Country:US
Mailing Address - Phone:603-216-9244
Mailing Address - Fax:603-681-0567
Practice Address - Street 1:130 MAIN ST STE 203C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3173
Practice Address - Country:US
Practice Address - Phone:603-216-9244
Practice Address - Fax:603-681-0567
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30421665Medicaid
NH343959OtherMAGELLAN