Provider Demographics
NPI:1497991731
Name:RILEY, SHELBY LAKE (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:LAKE
Last Name:RILEY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MYSTIC LN STE A
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1942
Mailing Address - Country:US
Mailing Address - Phone:610-883-3333
Mailing Address - Fax:
Practice Address - Street 1:20 MYSTIC LN STE A
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1942
Practice Address - Country:US
Practice Address - Phone:610-883-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000477106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist