Provider Demographics
NPI:1558032722
Name:AREVALO, SHELCY ADRIANA
Entity Type:Individual
Prefix:
First Name:SHELCY
Middle Name:ADRIANA
Last Name:AREVALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6393 NIGHTINGALE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6966
Mailing Address - Country:US
Mailing Address - Phone:805-612-1194
Mailing Address - Fax:
Practice Address - Street 1:6393 NIGHTINGALE ST APT 202
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6966
Practice Address - Country:US
Practice Address - Phone:805-612-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health