Provider Demographics
NPI:1033493432
Name:SHUCK, KATY WHITNEY (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATY
Middle Name:WHITNEY
Last Name:SHUCK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 LAKESIDE CENTRE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6593
Mailing Address - Country:US
Mailing Address - Phone:877-367-1763
Mailing Address - Fax:423-787-8794
Practice Address - Street 1:2035 LAKESIDE CENTRE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6593
Practice Address - Country:US
Practice Address - Phone:877-367-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN620515531104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506510Medicaid