Provider Demographics
NPI:1922137793
Name:CRENSHAW, SHIRLEY DIANE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:DIANE
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 SCHUETZ ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4972
Mailing Address - Country:US
Mailing Address - Phone:314-374-4753
Mailing Address - Fax:314-222-4939
Practice Address - Street 1:11030 SCHUETZ ROAD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4972
Practice Address - Country:US
Practice Address - Phone:314-374-4753
Practice Address - Fax:314-222-4939
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0096851041C0700X
MO0051581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499999415Medicaid