Healthcare Provider Details

I. General information

NPI: 1831511351
Provider Name (Legal Business Name): WILLIAM DANIEL SHIRLEY LPC-MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 09/01/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 BLUEGRASS ROAD
KNOXVILLE TN
37922
US

IV. Provider business mailing address

7700 GLEASON DRIVE 37D
KNOXVILLE TN
37919
US

V. Phone/Fax

Practice location:
  • Phone: 865-523-4704
  • Fax:
Mailing address:
  • Phone: 731-607-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5863
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: