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General NPI Number Information
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NPI Number | 1184135154
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Entity Type | Individual
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Provider Name | LAURA SHACKLETTE LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 728 CHESTNUT ST STE 202
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City | BOWLING GREEN
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State | KY
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Zip | 42101-6922
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Country | US
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Telephone | 270-202-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 728 CHESTNUT ST STE 202
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City | BOWLING GREEN
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State | KY
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Zip | 42101-6922
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Country | US
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Telephone | 270-202-8669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 275547
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License Number State | KY
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