Provider Demographics
NPI:1194150102
Name:MEEK, SHAUN LANCEINE (LCMFT)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:LANCEINE
Last Name:MEEK
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:SHAUN
Other - Middle Name:L
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0001
Mailing Address - Country:US
Mailing Address - Phone:620-515-1907
Mailing Address - Fax:620-222-9316
Practice Address - Street 1:509 MAPLE ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-4814
Practice Address - Country:US
Practice Address - Phone:620-515-1907
Practice Address - Fax:620-222-9316
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2557106H00000X
KS2733106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201085550AMedicaid