Provider Demographics
NPI:1760153274
Name:WILLEMS, SHELBIE LAUREN (MSED)
Entity Type:Individual
Prefix:
First Name:SHELBIE
Middle Name:LAUREN
Last Name:WILLEMS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N SAUNDERS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5117
Mailing Address - Country:US
Mailing Address - Phone:480-239-6930
Mailing Address - Fax:
Practice Address - Street 1:4040 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3003
Practice Address - Country:US
Practice Address - Phone:215-895-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health