Provider Demographics
NPI:1992991855
Name:SHELBY COUNSELING ASSOCIATES, PSC
Entity type:Organization
Organization Name:SHELBY COUNSELING ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:JEANINE
Authorized Official - Last Name:BROYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-8880
Mailing Address - Street 1:12701 TOWNEPARK WAY
Mailing Address - Street 2:BARKLEY BLDG STE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2387
Mailing Address - Country:US
Mailing Address - Phone:502-254-8880
Mailing Address - Fax:502-254-8870
Practice Address - Street 1:12701 TOWNEPARK WAY
Practice Address - Street 2:BARKLEY BLDG STE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2387
Practice Address - Country:US
Practice Address - Phone:502-254-8880
Practice Address - Fax:502-254-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000332447OtherANTHEM
KY9285Medicare UPIN
KY000000332447OtherANTHEM