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NPI Code Detail

MEDICARE: SHELBY GERALDS

MEDICARE: SHELBY GERALDS
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

General Provider Information

NPI Number : 1275124687
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY GERALDS
Provider Business Mailing Address
First Line : 1942 E CANTRELL ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-3214
Country : US
Telephone Number : 217-433-6961
Fax Number :
Provider Business Practice Location Address
First Line : 1942 E CANTRELL ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-3214
Country : US
Telephone Number : 217-233-6811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2021
Last Update Date : 07/18/2025

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Directions to “ SHELBY GERALDS ” Practice Location

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