Provider Demographics
NPI:1588010805
Name:KOCHEL, SHELLEY (LMSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:KOCHEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22250 GREEN HILL RD APT 67
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4372
Mailing Address - Country:US
Mailing Address - Phone:248-953-8155
Mailing Address - Fax:734-845-3284
Practice Address - Street 1:2215 FULLER RD # 116C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:734-845-3906
Practice Address - Fax:734-845-3284
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010886881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical