Provider Demographics
NPI:1770512907
Name:BEHAVIORAL WELLNESS CENTER OF SHELBY
Entity Type:Organization
Organization Name:BEHAVIORAL WELLNESS CENTER OF SHELBY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-484-2100
Mailing Address - Street 1:123 W MARION ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5381
Mailing Address - Country:US
Mailing Address - Phone:704-484-2100
Mailing Address - Fax:704-484-0090
Practice Address - Street 1:123 W MARION ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5381
Practice Address - Country:US
Practice Address - Phone:704-484-2100
Practice Address - Fax:704-484-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005225Medicaid
NC89016GEMedicaid
NC6005225Medicaid
NC2346043AMedicare PIN