Provider Demographics
NPI:1295041531
Name:PLOTKIN, SHELLEY SIMSON (LMFT)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:SIMSON
Last Name:PLOTKIN
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:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:WINTERHAVEN
Mailing Address - State:CA
Mailing Address - Zip Code:92283-0642
Mailing Address - Country:US
Mailing Address - Phone:775-342-5972
Mailing Address - Fax:
Practice Address - Street 1:7669 E OLIVE ANN LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-7835
Practice Address - Country:US
Practice Address - Phone:775-342-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAMFC 28031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)