Provider Demographics
NPI:1639446776
Name:CAVIN, SHELLY SMITH (LPC)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:SMITH
Last Name:CAVIN
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 1:7451 ASPEN WOOD CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-2909
Mailing Address - Country:US
Mailing Address - Phone:817-999-5335
Mailing Address - Fax:
Practice Address - Street 1:7451 ASPEN WOOD CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-2909
Practice Address - Country:US
Practice Address - Phone:817-999-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13895101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor