Individual
MARK RANDALL SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED., L.P.C, CRAADC
Contact information
Practice address
1303 EDGEWOOD DR, JEFFERSON CITY, MO 65109-1943
(573) 529-9496
Mailing address
803 CARDINAL ST, JEFFERSON CITY, MO 65101-3750
(573) 529-9496
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
511
MO
101YM0800X
Mental Health Counselor
Primary
CS001167
MO
Other
Enumeration date
03/14/2018
Last updated
03/14/2018
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