Provider Demographics
NPI:1952834236
Name:OASIS HEALTH FOR MOOD & BODY, LLC
Entity Type:Organization
Organization Name:OASIS HEALTH FOR MOOD & BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JULES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLBY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, ADS
Authorized Official - Phone:231-944-8200
Mailing Address - Street 1:812 S GARFIELD AVE
Mailing Address - Street 2:STE J
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3456
Mailing Address - Country:US
Mailing Address - Phone:231-944-8200
Mailing Address - Fax:
Practice Address - Street 1:812 S GARFIELD AVE
Practice Address - Street 2:STE J
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3456
Practice Address - Country:US
Practice Address - Phone:231-944-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI640.101.4158261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)