Provider Demographics
NPI:1083761688
Name:WEBER, SHELLEY LEE (LMFT, LADC)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:LEE
Last Name:WEBER
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9768 SHADYMILL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1674
Mailing Address - Country:US
Mailing Address - Phone:702-371-0406
Mailing Address - Fax:702-363-2780
Practice Address - Street 1:2921 N TENAYA WAY
Practice Address - Street 2:SUITE 217
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1409
Practice Address - Country:US
Practice Address - Phone:702-371-0406
Practice Address - Fax:702-363-2780
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1105L101YA0400X
NV0967106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist