Provider Demographics
NPI:1902375868
Name:CRISP, SHELBY NICHOLE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:NICHOLE
Last Name:CRISP
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 1:504 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1125
Mailing Address - Country:US
Mailing Address - Phone:859-759-1223
Mailing Address - Fax:859-759-0970
Practice Address - Street 1:504 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1125
Practice Address - Country:US
Practice Address - Phone:859-759-1223
Practice Address - Fax:859-759-0970
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health