Provider Demographics
NPI:1518002286
Name:THOME, SHELLY (LPC, CCTP, CCTSI)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:
Last Name:THOME
Suffix:
Gender:F
Credentials:LPC, CCTP, CCTSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 W. HAPPY VALLEY ROAD
Mailing Address - Street 2:SUITE A104, #129
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-8730
Mailing Address - Country:US
Mailing Address - Phone:602-649-4040
Mailing Address - Fax:
Practice Address - Street 1:6635 W. HAPPY VALLEY ROAD
Practice Address - Street 2:SUITE A104, #129
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-8531
Practice Address - Country:US
Practice Address - Phone:602-649-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17691101Y00000X
AZLPC17691101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor