Provider Demographics
NPI:1124585815
Name:SHETLER, DAVID MARK
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARK
Last Name:SHETLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3797
Mailing Address - Country:US
Mailing Address - Phone:931-684-0522
Mailing Address - Fax:
Practice Address - Street 1:604 S WALL ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3797
Practice Address - Country:US
Practice Address - Phone:931-684-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor