Provider Demographics
NPI:1487008579
Name:BURNES, SHELLEY (MA, LPC, CAADC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BURNES
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2662
Mailing Address - Country:US
Mailing Address - Phone:231-346-5232
Mailing Address - Fax:231-922-4884
Practice Address - Street 1:747 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2662
Practice Address - Country:US
Practice Address - Phone:231-346-5232
Practice Address - Fax:231-922-4884
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009957101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor