Provider Demographics
NPI:1225436959
Name:STRETCH, SHELLEY (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:STRETCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8604 GRANTWOOD TRAILS CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-1146
Mailing Address - Country:US
Mailing Address - Phone:314-882-0619
Mailing Address - Fax:660-665-3989
Practice Address - Street 1:655 CRAIG RD STE 320
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7171
Practice Address - Country:US
Practice Address - Phone:314-772-2205
Practice Address - Fax:314-772-9264
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012037164101YP2500X
MO2102037164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty