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NPI Code Detail

MEDICARE: SHELBY HOLLEY LPC

MEDICARE: SHELBY HOLLEY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1841805975
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY HOLLEY LPC
Provider Business Mailing Address
First Line : 2031 N MOUNT JULIET RD STE 201
Second Line :
City : MT JULIET
State : TN
Zip : 37122-4498
Country : US
Telephone Number : 615-438-3615
Fax Number :
Provider Business Practice Location Address
First Line : 2031 N MOUNT JULIET RD STE 201
Second Line :
City : MT JULIET
State : TN
Zip : 37122-4498
Country : US
Telephone Number : 615-438-3615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2020
Last Update Date : 09/15/2020

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Directions to “ SHELBY HOLLEY LPC” Practice Location

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