Healthcare Provider Details

I. General information

NPI: 1851960561
Provider Name (Legal Business Name): ELIZABETH ANN SHAIN MME, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN LOSSON MT-BC

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CHERRY HILL DR STE 102
COLUMBIA MO
65203-5920
US

IV. Provider business mailing address

1905 CHERRY HILL DR STE 102
COLUMBIA MO
65203-5920
US

V. Phone/Fax

Practice location:
  • Phone: 573-303-5772
  • Fax:
Mailing address:
  • Phone: 816-714-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: