Individual
MR. JAY RICHARD SHILLING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1416 S ROAN ST, OAKS CASTLE CLINIC, JOHNSON CITY, TN 37601-7332
(423) 979-6257
Mailing address
PO BOX 1166, JOHNSON CITY, TN 37605-1166
(423) 979-6265
(423) 979-6285
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW00091
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47574
CIGNA
—
01
—
5426182
AETNA
—
Enumeration date
11/02/2005
Last updated
07/08/2007
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