Provider Demographics
NPI:1073723177
Name:WOLFE, SHELLEY LYNETTE (PH D)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:LYNETTE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10182 E. PASEO JUAN TABO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747
Mailing Address - Country:US
Mailing Address - Phone:928-322-7462
Mailing Address - Fax:
Practice Address - Street 1:207 DEL PARQUE ST. 9TH FLOOR
Practice Address - Street 2:
Practice Address - City:SJ
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:877-342-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005424101YM0800X
AZ4520103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health