Provider Demographics
NPI:1154507721
Name:BINGHAM, SHELLY LYNNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:LYNNE
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:SHELLY
Other - Middle Name:LYNNE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-0278
Mailing Address - Country:US
Mailing Address - Phone:423-442-2622
Mailing Address - Fax:423-442-5760
Practice Address - Street 1:4798 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-1287
Practice Address - Country:US
Practice Address - Phone:423-442-2622
Practice Address - Fax:423-442-5760
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN60841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical