MEDICARE: TEARNEY SHATRELL BEAM LCSWA

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
1	104100000X	Social Worker	P023374	NC
2	1041C0700X	Clinical Social Worker	P023374	NC

General Provider Information

NPI Number	:	1912615048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEARNEY SHATRELL BEAM LCSWA

Provider Business Mailing Address
First Line	:	9536 BLUE KNOLL CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-0202
Country	:	US
Telephone Number	:	704-371-1371
Fax Number	:

Provider Business Practice Location Address
First Line	:	9536 BLUE KNOLL CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-0202
Country	:	US
Telephone Number	:	704-371-1371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	01/26/2026

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