Provider Demographics
NPI:1366262479
Name:SHELNUTT, JEREMIAH JAMES (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JAMES
Last Name:SHELNUTT
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BIRD CIR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4406
Mailing Address - Country:US
Mailing Address - Phone:423-278-4860
Mailing Address - Fax:
Practice Address - Street 1:104 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4257
Practice Address - Country:US
Practice Address - Phone:423-278-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000006618101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor