Provider Demographics
NPI:1487673745
Name:SHELY, TYLER GILBERT III (LCSW, MSW, ACSW)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:GILBERT
Last Name:SHELY
Suffix:III
Gender:M
Credentials:LCSW, MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5336 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-5579
Mailing Address - Country:US
Mailing Address - Phone:828-326-3809
Mailing Address - Fax:
Practice Address - Street 1:1120 FAIRGROVE CHURCH RD
Practice Address - Street 2:SUITE 12
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9630
Practice Address - Country:US
Practice Address - Phone:828-326-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487673745Medicaid
NC117WOtherNC BCBS
NC1487673745Medicaid
NC2870524BMedicare Oscar/Certification