Provider Demographics
NPI:1134919087
Name:SHADDEN, MARCY (LCSW)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:SHADDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 JESSICA LN
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2639
Mailing Address - Country:US
Mailing Address - Phone:816-710-5883
Mailing Address - Fax:
Practice Address - Street 1:5702 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64129-2547
Practice Address - Country:US
Practice Address - Phone:816-519-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024010059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)