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NPI Code Detail

MEDICARE: MR. JAY RICHARD SHILLING LCSW

MEDICARE: MR. JAY RICHARD SHILLING LCSW
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
11041C0700XClinical Social WorkerLSW00091TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
147574OTHERCIGNA
25426182OTHERAETNA

General Provider Information

NPI Number : 1063403533
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAY RICHARD SHILLING LCSW
Provider Business Mailing Address
First Line : PO BOX 1166
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37605-1166
Country : US
Telephone Number : 423-979-6265
Fax Number : 423-979-6285
Provider Business Practice Location Address
First Line : 1416 S ROAN ST
Second Line : OAKS CASTLE CLINIC
City : JOHNSON CITY
State : TN
Zip : 37601-7332
Country : US
Telephone Number : 423-979-6257
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 07/08/2007

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