Provider Demographics
NPI:1922690536
Name:SULLIVAN, SHELBIE L (MA, MS, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:SHELBIE
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E SMITH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1655
Mailing Address - Country:US
Mailing Address - Phone:219-406-0310
Mailing Address - Fax:
Practice Address - Street 1:13500 WATERTOWN PLANK RD STE 202
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2260
Practice Address - Country:US
Practice Address - Phone:219-406-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8043-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional