Provider Demographics
NPI:1376313825
Name:SHELBY CAVENDER THERAPY, PLLC
Entity Type:Organization
Organization Name:SHELBY CAVENDER THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-648-9235
Mailing Address - Street 1:7030 DOGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8113
Mailing Address - Country:US
Mailing Address - Phone:616-648-9236
Mailing Address - Fax:
Practice Address - Street 1:4920 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1010
Practice Address - Country:US
Practice Address - Phone:616-648-9235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty