Provider Demographics
NPI:1215135694
Name:MCDANIEL, MICHAEL SHAWN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-0576
Mailing Address - Country:US
Mailing Address - Phone:888-409-9303
Mailing Address - Fax:
Practice Address - Street 1:1000 E 24TH ST UNIT 2C
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2776
Practice Address - Country:US
Practice Address - Phone:816-404-3710
Practice Address - Fax:816-404-3611
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007033941103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497300806Medicaid