Provider Demographics
NPI:1679371223
Name:BOBBITT, SHANA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:MARIE
Last Name:BOBBITT
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 RIVER LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3294
Mailing Address - Country:US
Mailing Address - Phone:618-420-6393
Mailing Address - Fax:
Practice Address - Street 1:309 RIVER LAUREL DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3294
Practice Address - Country:US
Practice Address - Phone:618-420-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021018938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional