Provider Demographics
NPI:1861579773
Name:BRENDE, SHANNA (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:
Last Name:BRENDE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3413
Mailing Address - Country:US
Mailing Address - Phone:816-554-4287
Mailing Address - Fax:
Practice Address - Street 1:2980 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-3413
Practice Address - Country:US
Practice Address - Phone:816-554-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001016100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional