Provider Demographics
NPI:1306400239
Name:SHELBY DEBRUYN COUNSELING, LLC
Entity Type:Organization
Organization Name:SHELBY DEBRUYN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBRUYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-255-3070
Mailing Address - Street 1:251 CENTRAL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4188
Mailing Address - Country:US
Mailing Address - Phone:978-255-3070
Mailing Address - Fax:
Practice Address - Street 1:251 CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4188
Practice Address - Country:US
Practice Address - Phone:603-321-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty