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General NPI Number Information
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NPI Number | 1861088551
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Entity Type | Organization
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Legal Business Name | THE SHEA CENTER FOR MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 3311 JANELL RD
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City | LOUISVILLE
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State | KY
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Zip | 40216-4707
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Country | US
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Telephone | 502-707-6177
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Fax | 502-632-1432
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Provider Business Mailing Address
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Address Line | 3311 JANELL RD
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City | LOUISVILLE
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State | KY
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Zip | 40216-4707
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Country | US
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Telephone | 502-707-6177
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Fax | 502-632-1432
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATOR
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Name | JACQUELINE SANDERS
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Credential |
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Telephone | 502-630-2036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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