Provider Demographics
NPI:1770220725
Name:CLARKE, SHELBY LYNE (MA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 SW 184TH TER
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3869
Mailing Address - Country:US
Mailing Address - Phone:503-713-3154
Mailing Address - Fax:
Practice Address - Street 1:2855 E HAYES ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1390
Practice Address - Country:US
Practice Address - Phone:503-395-7109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health