Provider Demographics
NPI:1114225828
Name:SHELLEY S. BERVEN AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SHELLEY S. BERVEN AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:SEARS
Authorized Official - Last Name:BERVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-224-3035
Mailing Address - Street 1:790 CLEVELAND AVE S
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3858
Mailing Address - Country:US
Mailing Address - Phone:651-224-3035
Mailing Address - Fax:651-690-0968
Practice Address - Street 1:790 CLEVELAND AVE S
Practice Address - Street 2:SUITE 207
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3858
Practice Address - Country:US
Practice Address - Phone:651-224-3035
Practice Address - Fax:651-690-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN068451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty