Provider Demographics
NPI:1003301888
Name:PARKMAN, SHELLY JANE (LCAC, LPC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:JANE
Last Name:PARKMAN
Suffix:
Gender:F
Credentials:LCAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E 7TH ST. SUITE 1E
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711
Mailing Address - Country:US
Mailing Address - Phone:406-563-7863
Mailing Address - Fax:406-563-2387
Practice Address - Street 1:118 E 7TH ST. SUITE 1E
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711
Practice Address - Country:US
Practice Address - Phone:406-563-7863
Practice Address - Fax:406-563-2387
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90101YA0400X
KS882101YP2500X
KS692101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional