Provider Demographics
NPI:1205964863
Name:KOORS, SHIRLEY R (MMFT, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:R
Last Name:KOORS
Suffix:
Gender:F
Credentials:MMFT, LPC-MHSP
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:GEVEDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:942 COUNTY ROAD 609
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-6365
Mailing Address - Country:US
Mailing Address - Phone:931-797-8461
Mailing Address - Fax:
Practice Address - Street 1:942 COUNTY ROAD 609
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303
Practice Address - Country:US
Practice Address - Phone:931-797-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TN2742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525402Medicaid