Provider Demographics
NPI:1508559774
Name:SHUFFETT, BEVERLY LYNNE (MSSW, LCADC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LYNNE
Last Name:SHUFFETT
Suffix:
Gender:F
Credentials:MSSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 RALPH VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-7797
Mailing Address - Country:US
Mailing Address - Phone:270-465-1134
Mailing Address - Fax:
Practice Address - Street 1:1327 E BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1599
Practice Address - Country:US
Practice Address - Phone:270-789-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY284568101YA0400X
KY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)