Provider Demographics
NPI:1629458542
Name:PLICHOTA, SHELBY ROSE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:ROSE
Last Name:PLICHOTA
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 1:11652 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-8465
Mailing Address - Country:US
Mailing Address - Phone:616-897-5373
Mailing Address - Fax:616-897-5954
Practice Address - Street 1:11652 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8465
Practice Address - Country:US
Practice Address - Phone:616-897-5373
Practice Address - Fax:616-897-5954
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010979071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical