Provider Demographics
NPI:1962020974
Name:MAINVILLE, SHELBY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MAINVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2208
Mailing Address - Country:US
Mailing Address - Phone:970-648-7128
Mailing Address - Fax:833-324-1646
Practice Address - Street 1:300 E DENVER AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2210
Practice Address - Country:US
Practice Address - Phone:970-648-7128
Practice Address - Fax:833-324-1646
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
COCSW.099283501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker