Provider Demographics
NPI:1609942887
Name:SHELL, BRENDA S (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:SHELL
Suffix:
Gender:F
Credentials:MA, LMFT
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 436046
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-6046
Mailing Address - Country:US
Mailing Address - Phone:502-341-2411
Mailing Address - Fax:
Practice Address - Street 1:13000 EQUITY PLACE
Practice Address - Street 2:STE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3976
Practice Address - Country:US
Practice Address - Phone:502-341-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002033A106H00000X
CAMFC 40254 (INACTIVE)106H00000X
KY106668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30606099Medicaid