Individual
LAURA SHACKLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
728 CHESTNUT ST STE 202, BOWLING GREEN, KY 42101-6922
(270) 202-8669
Mailing address
728 CHESTNUT ST STE 202, BOWLING GREEN, KY 42101-6922
(270) 202-8669
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
275547
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
10/18/2017
Last updated
05/19/2022
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