Provider Demographics
NPI:1356687636
Name:CLUBB, SHELLY FAIN (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:FAIN
Last Name:CLUBB
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 MEADOWS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8419
Mailing Address - Country:US
Mailing Address - Phone:720-455-3750
Mailing Address - Fax:720-455-3751
Practice Address - Street 1:4611 PLETTNER LN
Practice Address - Street 2:SUITE 104
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7396
Practice Address - Country:US
Practice Address - Phone:720-448-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health