Healthcare Provider Details

I. General information

NPI: 1003216581
Provider Name (Legal Business Name): SHELBY LYN PASCOE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR.
ST. LOUIS MO
63125
US

IV. Provider business mailing address

1 JEFFERSON BARRACKS DR.
ST. LOUIS MO
63125
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-652-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2018009771
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: