Provider Demographics
NPI:1538690664
Name:SHELLMIRE UNLIMITED
Entity Type:Organization
Organization Name:SHELLMIRE UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHELLMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-676-3710
Mailing Address - Street 1:5257 NE MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3282
Mailing Address - Country:US
Mailing Address - Phone:503-676-3710
Mailing Address - Fax:503-331-2549
Practice Address - Street 1:5257 NE MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3282
Practice Address - Country:US
Practice Address - Phone:503-676-3710
Practice Address - Fax:503-331-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty