Provider Demographics
NPI:1083990832
Name:SHELLENBARGER, TESS DIANE (LCPC, LPC, MAC, CADC)
Entity Type:Individual
Prefix:MS
First Name:TESS
Middle Name:DIANE
Last Name:SHELLENBARGER
Suffix:
Gender:F
Credentials:LCPC, LPC, MAC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX V
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-0076
Mailing Address - Country:US
Mailing Address - Phone:541-889-1050
Mailing Address - Fax:541-889-6524
Practice Address - Street 1:390 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2513
Practice Address - Country:US
Practice Address - Phone:541-889-1050
Practice Address - Fax:541-889-6524
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC2456OtherLINCENSED PROFESSIONAL COUNSELOR