Provider Demographics
NPI:1760784284
Name:STOLESEN, SHELLY NOREEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:NOREEN
Last Name:STOLESEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 119
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3009
Mailing Address - Country:US
Mailing Address - Phone:415-888-8084
Mailing Address - Fax:415-979-9771
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 119
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3009
Practice Address - Country:US
Practice Address - Phone:415-888-8084
Practice Address - Fax:415-979-9771
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7550103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist