Provider Demographics
NPI:1134357197
Name:BENTLEY, SHAWN (PLPC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 68 BOX 83
Mailing Address - Street 2:
Mailing Address - City:CAULFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65626-9408
Mailing Address - Country:US
Mailing Address - Phone:417-372-2924
Mailing Address - Fax:
Practice Address - Street 1:HC 68 BOX 83
Practice Address - Street 2:
Practice Address - City:CAULFIELD
Practice Address - State:MO
Practice Address - Zip Code:65626-9408
Practice Address - Country:US
Practice Address - Phone:417-372-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional