Provider Demographics
NPI:1962284539
Name:LEVY, SHELBY ANN
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN
Last Name:LEVY
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 1:2703 SE G ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3741
Mailing Address - Country:US
Mailing Address - Phone:479-644-7413
Mailing Address - Fax:479-397-4340
Practice Address - Street 1:2703 SE G ST STE 1
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3741
Practice Address - Country:US
Practice Address - Phone:479-644-7413
Practice Address - Fax:479-397-4340
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2510002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional