Provider Demographics
NPI:1598114506
Name:BURNS, SHELLEY (LSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-0202
Mailing Address - Country:US
Mailing Address - Phone:419-483-9411
Mailing Address - Fax:419-483-9247
Practice Address - Street 1:817 KILBOURNE ST
Practice Address - Street 2:SUITE G
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9431
Practice Address - Country:US
Practice Address - Phone:419-483-9411
Practice Address - Fax:419-483-9247
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.16003171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical