Provider Demographics
NPI:1417313677
Name:DAVIS, SHELLEY EILEEN (CADC I, QMHA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:EILEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CADC I, QMHA
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:EILEEN
Other - Last Name:ENQUIST/BLAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SHELLEY E BLAKE
Mailing Address - Street 1:4691 WESTLAWN CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5541
Mailing Address - Country:US
Mailing Address - Phone:971-240-3227
Mailing Address - Fax:
Practice Address - Street 1:960 LIBERTY ST SE STE 120
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4165
Practice Address - Country:US
Practice Address - Phone:503-588-2804
Practice Address - Fax:503-371-6743
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-10-21101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)