Provider Demographics
NPI:1427521608
Name:HOLLIMAN, SHAWN STACEY (MA)
Entity type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:STACEY
Last Name:HOLLIMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3421
Mailing Address - Country:US
Mailing Address - Phone:314-344-6700
Mailing Address - Fax:
Practice Address - Street 1:2130 MCKELVEY HILL DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-4002
Practice Address - Country:US
Practice Address - Phone:314-494-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health