Provider Demographics
NPI:1407201635
Name:ROEMER, SHELBY (LMFT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ROEMER
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 1:5053 LA MART DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5993
Mailing Address - Country:US
Mailing Address - Phone:951-675-7072
Mailing Address - Fax:
Practice Address - Street 1:5053 LA MART DR STE 207
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5990
Practice Address - Country:US
Practice Address - Phone:951-675-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT36580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist