1568659498 NPI number — SHELBY COUNSELING ASSOCIATES, PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568659498 NPI number — SHELBY COUNSELING ASSOCIATES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELBY COUNSELING ASSOCIATES, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1568659498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12701 TOWNEPARK WAY
Provider Second Line Business Mailing Address:
BARKLEY BLDG STE 200
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-2387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-254-8880
Provider Business Mailing Address Fax Number:
502-254-8870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 STONECREST CT
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40065-8173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-2025
Provider Business Practice Location Address Fax Number:
502-254-8870
Provider Enumeration Date:
09/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROYLES
Authorized Official First Name:
NICHOLE
Authorized Official Middle Name:
JEANINE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
502-254-8880

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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