Provider Demographics
NPI:1275074759
Name:SHELLEY, EDWARD JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOHN
Last Name:SHELLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 ZURICH CT
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-7020
Mailing Address - Country:US
Mailing Address - Phone:702-336-4345
Mailing Address - Fax:
Practice Address - Street 1:216 N PRATT AVE
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4722
Practice Address - Country:US
Practice Address - Phone:775-450-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7227-S104100000X
NV9082-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker