Provider Demographics
NPI:1043515406
Name:INEZ SHIELDS LLC
Entity type:Organization
Organization Name:INEZ SHIELDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:4176-671-7689
Mailing Address - Street 1:203 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1426
Mailing Address - Country:US
Mailing Address - Phone:417-667-1768
Mailing Address - Fax:417-667-7382
Practice Address - Street 1:203 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1426
Practice Address - Country:US
Practice Address - Phone:417-667-1768
Practice Address - Fax:417-667-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000175971251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health