Provider Demographics
NPI:1295778249
Name:SHIELDS-PFANNENSTIEL, MARIE (LMLP,LCMFT,LCP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:SHIELDS-PFANNENSTIEL
Suffix:
Gender:F
Credentials:LMLP,LCMFT,LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 HOUSTON STREET
Mailing Address - Street 2:PO BOX 747
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-0747
Mailing Address - Country:US
Mailing Address - Phone:785-587-4300
Mailing Address - Fax:785-587-4321
Practice Address - Street 1:2001 CLAFLIN RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3415
Practice Address - Country:US
Practice Address - Phone:785-587-4300
Practice Address - Fax:785-587-4321
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0130101Y00000X
KS236101YM0800X
KS190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200450720AMedicaid
11658852OtherCAQH
KS856677OtherBCBS