Provider Demographics
NPI:1063403533
Name:SHILLING, JAY RICHARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:RICHARD
Last Name:SHILLING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37605-1166
Mailing Address - Country:US
Mailing Address - Phone:423-979-6265
Mailing Address - Fax:423-979-6285
Practice Address - Street 1:1416 S ROAN ST
Practice Address - Street 2:OAKS CASTLE CLINIC
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7332
Practice Address - Country:US
Practice Address - Phone:423-979-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW000911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
47574OtherCIGNA
5426182OtherAETNA
5426182OtherAETNA