Individual
MICHAEL DAVID SHACKLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
512 VETERANS MEMORIAL HWY, SCOTTSVILLE, KY 42164-8443
(270) 901-5000
Mailing address
380 SUWANNEE TRAIL ST, BOWLING GREEN, KY 42103-7956
(270) 901-5000
(270) 842-5268
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
283406
KY
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100878810
—
KY
Enumeration date
05/31/2018
Last updated
03/03/2026
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