Provider Demographics
NPI:1801409412
Name:HOLBROOK, SHANNON LYNCH (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNCH
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:249 CLARKSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2497
Mailing Address - Country:US
Mailing Address - Phone:636-256-0600
Mailing Address - Fax:
Practice Address - Street 1:249 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2497
Practice Address - Country:US
Practice Address - Phone:636-256-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker