Provider Demographics
NPI:1154684843
Name:PELLETIER, SHELBY MARIE (LCPC-C)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:MARIE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:MARIE
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC-C
Mailing Address - Street 1:180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6666
Mailing Address - Country:US
Mailing Address - Phone:207-872-5300
Mailing Address - Fax:
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-872-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional