MEDICARE: JENNY SHEALY, LCSW PA

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	251S00000X	Community/Behavioral Health Agency	C005923	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2853495	OTHER		MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1578958104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNY SHEALY, LCSW PA

Provider Business Mailing Address
First Line	:	67 CHARLOTTE ST
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-2435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 CHARLOTTE ST
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-2435
Country	:	US
Telephone Number	:	828-279-5369
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNIFER SHEALY
Credential	:	LCSW
Telephone Number	:	828-279-5369

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	03/31/2015

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