Provider Demographics
NPI:1255684940
Name:SHELLEY M. DOYLE, MA LPC LLC
Entity Type:Organization
Organization Name:SHELLEY M. DOYLE, MA LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:973-668-8870
Mailing Address - Street 1:46 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1935
Mailing Address - Country:US
Mailing Address - Phone:973-668-8870
Mailing Address - Fax:
Practice Address - Street 1:46 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1935
Practice Address - Country:US
Practice Address - Phone:973-668-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00406900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty