Provider Demographics
NPI:1558309765
Name:MCCURDY, SHANE D (LSCSW)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:D
Last Name:MCCURDY
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9415 EAST HARRY, BUILDING 3
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207
Mailing Address - Country:US
Mailing Address - Phone:316-202-2110
Mailing Address - Fax:316-226-8648
Practice Address - Street 1:9415 E HARRY ST
Practice Address - Street 2:STE 306
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5077
Practice Address - Country:US
Practice Address - Phone:316-202-2110
Practice Address - Fax:316-226-8648
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS5670104100000X
KS38111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201443OtherBLUE CROSS BLUE SHIELD
KS8966OtherPREFERRED HEALTH SYSTEMS