1417274671 NPI number — MRS. CHRISTIE SHAWN HELM LCSW

Table of content: MRS. CHRISTIE SHAWN HELM LCSW (NPI 1417274671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417274671 NPI number — MRS. CHRISTIE SHAWN HELM LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HELM
Provider First Name:
CHRISTIE
Provider Middle Name:
SHAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417274671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 REYNOLDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASGOW
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42141-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-678-4801
Provider Business Mailing Address Fax Number:
270-678-3866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1048 ASHLEY ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42103-2449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-904-6567
Provider Business Practice Location Address Fax Number:
270-904-6570
Provider Enumeration Date:
04/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3264 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)