Shelby Hart
Individual provider Active NPI Mental Health Counselor · Du Quoin, IL
NPI 1477068492 · NPPES record last updated Dec 13, 2017
Key facts
- NPI
- 1477068492
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 1016 S Madison St
Du Quoin, IL 62832-2442 - Phone
- (618) 542-4357
- Fax
- (618) 542-3442
- NPI assigned
- Dec 13, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
1016 S Madison St
Du Quoin, IL 62832-2442
Mailing address
1016 S Madison St
Du Quoin, IL 62832-2442
Phone (618) 542-4357
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 376130900001 | Medicaid | IL |
Other providers in Du Quoin, IL
- Anita Jo Gross
- Samantha Kay Gross
- T'Aira Hampleman
- Elizabeth L. Harbison
- Angela Rae Harsy
- Robert Erhardt Heisner II
- Adriane Marie Helmer
- Adam Jordan Henson
- Kurt Hermann
- Carol S Hicks
All providers in Du Quoin, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.