| Doctor Name: | SHAWN C BOLES |
| NPI Number: | 1952543001 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC, NCC |
| License Number: | 2008018335 |
| Business Practice Address: | 4300 Gravois Rd House Springs, MO - 630512304 |
| Business Phone Number: | 6363210150 |
| Business Fax Number: | 6363755157 |
| Mailing Address: | 227 Main St, FESTUS |
| State: | MO |
| Postal Code: | 630281952 |
| Phone Number: | 6369312700 |
| Fax Number: | 6369315304 |
| NPI Enumeration Date: | 04/02/2009 |
| NPI Last Update Date: | 03/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2008018335 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |