Provider Demographics
NPI:1891261269
Name:SHIELS, HOLLY (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SHIELS
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 OLIVE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2377
Mailing Address - Country:US
Mailing Address - Phone:314-239-0821
Mailing Address - Fax:
Practice Address - Street 1:617 GEOFFRY LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-4676
Practice Address - Country:US
Practice Address - Phone:314-675-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021046280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health