Provider Demographics
NPI:1245776335
Name:SMITH, SHELBY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 OGEMAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-1421
Mailing Address - Country:US
Mailing Address - Phone:616-295-3770
Mailing Address - Fax:
Practice Address - Street 1:650 E 5TH ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1268
Practice Address - Country:US
Practice Address - Phone:989-705-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor