Provider Demographics
NPI:1962858654
Name:MOLLOSEAU, SHELBY PATRICIA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:PATRICIA
Last Name:MOLLOSEAU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:PATRICIA
Other - Last Name:YEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:335 PINE ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1329
Mailing Address - Country:US
Mailing Address - Phone:810-656-9542
Mailing Address - Fax:
Practice Address - Street 1:1555 W BIG BEAVER RD FL 2
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3525
Practice Address - Country:US
Practice Address - Phone:617-379-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical