1023686417 NPI number — SHELBY SIPE PROFESSIONAL COUNSELING

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 1023686417 NPI number — SHELBY SIPE PROFESSIONAL COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELBY SIPE PROFESSIONAL COUNSELING
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:
1023686417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 BLASTED ROCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36830-4374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-544-8413
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
861E N DEAN RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36830-9419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-707-8639
Provider Business Practice Location Address Fax Number:
334-888-8298
Provider Enumeration Date:
06/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SIPE
Authorized Official First Name:
SHELBY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
317-544-8413

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)

  • Identifier: 4437 . This is a "ALABAMA BOARD OF EXAMINERS IN COUNSELING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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