Provider Demographics
NPI:1275282360
Name:SHEELEY, SAMUEL (LPC-MHSP(TEMP), NCC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SHEELEY
Suffix:
Gender:M
Credentials:LPC-MHSP(TEMP), NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 21ST AVE S STE 405
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4929
Mailing Address - Country:US
Mailing Address - Phone:615-668-2607
Mailing Address - Fax:
Practice Address - Street 1:2200 21ST AVE S STE 405
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4929
Practice Address - Country:US
Practice Address - Phone:615-668-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5230101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor