Theo Shackleford is a Peer Specialist based in Louisa, KY. Theo Shackleford practices in Louisa, KY. The NPI Number for Theo Shackleford is 1538737986 and holds a License No. (Kentucky).
The current practice location address for Theo Shackleford is 125 S Main Cross St, Louisa, KY and can be reached out via phone at 606-638-0938.
Location: 125 S Main Cross St, Louisa, KY, 41230-1065
Provider Profile Details
NPI Number
1538737986
Provider Name
Theo Shackleford
Credential
Provider Entity Type
Individual
Gender
Male
Address
125 S Main Cross St, Louisa, KY, 41230-1065
Phone Number
606-638-0938
Fax Number
Provider Enumeration Date
06/14/2021
Last Update Date
03/10/2024
Provider Business Practice Location Address Details
Address
125 S Main Cross St
City
State
Zip
41230-1065
Phone Number
606-638-0938
Fax Number
Provider Business Mailing Address Details
Address
125 S Main Cross St
City
State
Zip
41230-1065
Phone Number
606-638-0938
Fax Number
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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