Provider Demographics
NPI:1164561445
Name:BOYCE, SHELLEY K (LMHP, CPC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:K
Last Name:BOYCE
Suffix:
Gender:F
Credentials:LMHP, CPC
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 141
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-0141
Mailing Address - Country:US
Mailing Address - Phone:308-728-9979
Mailing Address - Fax:308-728-9980
Practice Address - Street 1:100 N 15TH ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1458
Practice Address - Country:US
Practice Address - Phone:308-728-9979
Practice Address - Fax:308-728-9980
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025457100Medicaid