Provider Demographics
NPI:1942420625
Name:SHELBY, SHARITA R (MA,LPC)
Entity Type:Individual
Prefix:
First Name:SHARITA
Middle Name:R
Last Name:SHELBY
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 CHARTER OAK PKWY APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5261
Mailing Address - Country:US
Mailing Address - Phone:314-369-4969
Mailing Address - Fax:
Practice Address - Street 1:1267 CHARTER OAK PKWY APT A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-5261
Practice Address - Country:US
Practice Address - Phone:314-369-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health