Provider Demographics
NPI:1962157131
Name:SHILTS, BRIAN (MS, LMHC, CSAYC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SHILTS
Suffix:
Gender:M
Credentials:MS, LMHC, CSAYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PEQUIGNOT DR
Mailing Address - Street 2:
Mailing Address - City:PIERCETON
Mailing Address - State:IN
Mailing Address - Zip Code:46562-9081
Mailing Address - Country:US
Mailing Address - Phone:574-400-2206
Mailing Address - Fax:
Practice Address - Street 1:27 PEQUIGNOT DR
Practice Address - Street 2:
Practice Address - City:PIERCETON
Practice Address - State:IN
Practice Address - Zip Code:46562-9081
Practice Address - Country:US
Practice Address - Phone:574-400-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000476A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INNONEOtherNONE