Provider Demographics
NPI:1225186711
Name:HUMMEL, SHELLY (LMFT)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 BINKLEY CHAPEL CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4244
Mailing Address - Country:US
Mailing Address - Phone:919-880-2566
Mailing Address - Fax:
Practice Address - Street 1:220 S WHITE ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2781
Practice Address - Country:US
Practice Address - Phone:919-880-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141G8OtherBCBS PROVIDER NUMBER