Provider Demographics
NPI:1801584602
Name:HAMS, SHANTEL NICO (LPC)
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:NICO
Last Name:HAMS
Suffix:
Gender:F
Credentials:LPC
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:816-203-8513
Mailing Address - Fax:816-886-7632
Practice Address - Street 1:11901 JESSICA LN
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2639
Practice Address - Country:US
Practice Address - Phone:816-203-8513
Practice Address - Fax:816-886-7632
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022016958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health