Healthcare Provider Details

I. General information

NPI: 1659219988
Provider Name (Legal Business Name): SHAYNA IRVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 CHERRY HILL DR STE 202
COLUMBIA MO
65203-5882
US

IV. Provider business mailing address

2012 CHERRY HILL DR STE 202
COLUMBIA MO
65203-5882
US

V. Phone/Fax

Practice location:
  • Phone: 573-200-6090
  • Fax:
Mailing address:
  • Phone: 573-200-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026009362
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: