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NPI Code Detail

MEDICARE: MR. SHANE LEE SEABOURN MSW

MEDICARE: MR. SHANE LEE SEABOURN MSW
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 Worker34006606AIN

General Provider Information

NPI Number : 1154378727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SHANE LEE SEABOURN MSW
Provider Business Mailing Address
First Line : 6651 SPARROWOOD DR
Second Line :
City : OAKLANDON
State : IN
Zip : 46236-8126
Country : US
Telephone Number : 918-961-2272
Fax Number :
Provider Business Practice Location Address
First Line : 5638 PROFESSIONAL CIR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46241-5042
Country : US
Telephone Number : 317-247-8900
Fax Number : 317-247-8935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 01/04/2013

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