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LOANNE M SHACKELFORD MSW LCSW

Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1902847759

Individual Registrant:
 LOANNE M SHACKELFORD MSW LCSW
Gender: F
Sole Proprietor

Location and contact information for practice:
200 S. MAIN ST.  LA VETA, CO 81055-0148 US
Tel: 719-742-3372  Fax: 719-742-3373

Contact information for business:
PO BOX 148  LA VETA, CO 81055-0148 US
Tel: 719-742-3372  Fax: 719-742-3373

Registration Information:
NPI: 1902847759
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
CO991075

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
035334CO05




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