Provider Demographics
NPI:1871231266
Name:WASHBURN, SHELBY (LPC-IT, ATR-P)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:LPC-IT, ATR-P
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2039
Mailing Address - Country:US
Mailing Address - Phone:608-279-1823
Mailing Address - Fax:
Practice Address - Street 1:1716 FORDEM AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4604
Practice Address - Country:US
Practice Address - Phone:608-221-3511
Practice Address - Fax:608-221-3514
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health