Provider Demographics
NPI:1619655776
Name:HARVEY, SHELLY MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8712 LIVINGSTON LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2228
Mailing Address - Country:US
Mailing Address - Phone:612-396-0943
Mailing Address - Fax:
Practice Address - Street 1:8712 LIVINGSTON LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-2228
Practice Address - Country:US
Practice Address - Phone:612-396-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1003602101YS0200X
MN02848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool