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NPI Code Detail

MEDICARE: MICHAEL DAVID SHACKLETTE LPCC

MEDICARE: MICHAEL DAVID SHACKLETTE LPCC
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
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor283406KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194217612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL DAVID SHACKLETTE LPCC
Provider Business Mailing Address
First Line : 380 SUWANNEE TRAIL ST
Second Line :
City : BOWLING GREEN
State : KY
Zip : 42103-7956
Country : US
Telephone Number : 270-901-5000
Fax Number : 270-842-5268
Provider Business Practice Location Address
First Line : 512 VETERANS MEMORIAL HWY
Second Line :
City : SCOTTSVILLE
State : KY
Zip : 42164-8443
Country : US
Telephone Number : 270-901-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2018
Last Update Date : 03/03/2026

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Directions to “ MICHAEL DAVID SHACKLETTE LPCC” Practice Location

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