=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962140954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARIEL R SHELBY LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2022
-----------------------------------------------------
Last Update Date | 03/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2152 OLD SPRINGVILLE RD
-----------------------------------------------------
City | CENTER POINT
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35215-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-838-6000
-----------------------------------------------------
Fax | 205-838-6922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5720 1ST AVE S
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35212-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-380-9455
-----------------------------------------------------
Fax | 205-380-9459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4964C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------