Provider Demographics
NPI:1639677453
Name:SIPE, SHELBY CLAIRE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:CLAIRE
Last Name:SIPE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:CLAIRE
Other - Last Name:SIPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:196 BLASTED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4374
Mailing Address - Country:US
Mailing Address - Phone:344-707-8369
Mailing Address - Fax:
Practice Address - Street 1:861 N DEAN RD STE E
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-9421
Practice Address - Country:US
Practice Address - Phone:334-707-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005659101YM0800X
GALPC011482101YP2500X
AL4437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC011482OtherGEORGIA COMPOSITE BOARD OF PC SW AND MFT
AL4437OtherALABAMA BOARD OF EXAMINERS IN COUNSELING
GAAPC005659OtherGEORGIA COMPOSITE BOARD OF PC SW AND MFT