Provider Demographics
NPI:1619332665
Name:MASH, SHELBY LEIGH
Entity Type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:LEIGH
Last Name:MASH
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 1:2315 N MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3880
Mailing Address - Country:US
Mailing Address - Phone:704-777-8504
Mailing Address - Fax:
Practice Address - Street 1:2315 N MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3880
Practice Address - Country:US
Practice Address - Phone:704-777-8504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor