1164486601 NPI number — MS. NANCY LEAH SHIRLEY MSW LCSW

Table of content: MS. NANCY LEAH SHIRLEY MSW LCSW (NPI 1164486601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164486601 NPI number — MS. NANCY LEAH SHIRLEY MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIRLEY
Provider First Name:
NANCY
Provider Middle Name:
LEAH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW 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:
1164486601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 657
Provider Second Line Business Mailing Address:
209 S PERU STREET SUITE 210 AND 211
Provider Business Mailing Address City Name:
CICERO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-984-5939
Provider Business Mailing Address Fax Number:
317-984-2465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 S PERU STREET
Provider Second Line Business Practice Location Address:
SUITE 210 211
Provider Business Practice Location Address City Name:
CICERO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-984-5939
Provider Business Practice Location Address Fax Number:
317-984-2465
Provider Enumeration Date:
04/13/2006

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: 104100000X , with the licence number:  34003573A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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