Provider Demographics
NPI:1538871371
Name:SHEA, ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 S BRENTWOOD BLVD STE 555
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1265
Mailing Address - Country:US
Mailing Address - Phone:314-912-2131
Mailing Address - Fax:314-784-5802
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 555
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1265
Practice Address - Country:US
Practice Address - Phone:314-912-2131
Practice Address - Fax:314-784-5802
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020030787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional