Provider Demographics
NPI:1871048876
Name:BECKLEY, SHELLEY EILEEN (LCSW)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:EILEEN
Last Name:BECKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:MO
Mailing Address - Zip Code:63437-3015
Mailing Address - Country:US
Mailing Address - Phone:660-651-4120
Mailing Address - Fax:
Practice Address - Street 1:309 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2143
Practice Address - Country:US
Practice Address - Phone:660-395-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019003938104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1871048876Medicaid