Provider Demographics
NPI:1679714992
Name:MEANS, SHELBY L
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:L
Last Name:MEANS
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 1:633 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-815-5801
Mailing Address - Fax:
Practice Address - Street 1:1200 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3908
Practice Address - Country:US
Practice Address - Phone:707-568-2300
Practice Address - Fax:707-568-2304
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health