Individual
MISS RUTH MARIE SHALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
308 MEDIC WAY, GREENCASTLE, IN 46135-2296
(765) 653-2669
(765) 653-8671
Mailing address
156 ANDREWS BLVD, PLAINFIELD, IN 46168-9769
(317) 371-2302
(765) 653-8671
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
34004443A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000207865
ANTHEM BCBS PROVIDER PIN
IN
Enumeration date
06/06/2006
Last updated
07/23/2007
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