Provider Demographics
NPI:1487975538
Name:SHOE, BREANNA (LCSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:SHOE
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:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:AR
Mailing Address - Zip Code:72433-0299
Mailing Address - Country:US
Mailing Address - Phone:870-886-1333
Mailing Address - Fax:
Practice Address - Street 1:503 SE LINDSEY ST
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:AR
Practice Address - Zip Code:72433-2224
Practice Address - Country:US
Practice Address - Phone:870-886-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 104100000X
AR7968-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251B00000XAgenciesCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial Worker