MEDICARE: SHELY ADAMSON LPC

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
1	101YM0800X	Mental Health Counselor	79495	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZGP838920457	OTHER	TX	BCBS TEXAS

General Provider Information

NPI Number	:	1245977123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELY ADAMSON LPC

Provider Business Mailing Address
First Line	:	2726 81ST ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-2228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2726 81ST ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-2228
Country	:	US
Telephone Number	:	915-276-2107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2022
Last Update Date	:	05/12/2022

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Directions to “ SHELY ADAMSON LPC” Practice Location

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