Provider Demographics
NPI:1043579642
Name:KELLEHER, SHAY AMBER
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:AMBER
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 KIRK AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2215
Mailing Address - Country:US
Mailing Address - Phone:412-561-3390
Mailing Address - Fax:412-561-5902
Practice Address - Street 1:250 MOUNT LEBANON BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1252
Practice Address - Country:US
Practice Address - Phone:412-561-3390
Practice Address - Fax:412-561-5902
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional