MEDICARE: INEZ SHIELDS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	2000175971	MO

General Provider Information

NPI Number	:	1043515406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INEZ SHIELDS LLC

Provider Business Mailing Address
First Line	:	203 W 11TH ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1426
Country	:	US
Telephone Number	:	417-667-1768
Fax Number	:	417-667-7382

Provider Business Practice Location Address
First Line	:	203 W 11TH ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1426
Country	:	US
Telephone Number	:	417-667-1768
Fax Number	:	417-667-7382

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	VALERIE ANN BARNHART
Credential	:	LPC
Telephone Number	:	41766717689

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	01/17/2011

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Directions to “INEZ SHIELDS LLC ” Practice Location

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