Provider Demographics
NPI:1629431150
Name:BUECHLER, SHANNON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:BUECHLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 CLAYTON AVE
Mailing Address - Street 2:CALL CENTER
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1718
Mailing Address - Country:US
Mailing Address - Phone:314-747-4577
Mailing Address - Fax:
Practice Address - Street 1:4249 CLAYTON AVE
Practice Address - Street 2:CALL CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1718
Practice Address - Country:US
Practice Address - Phone:314-747-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010038928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional