Provider Demographics
NPI:1972286052
Name:SHELLBE, RICHARD AMOS (PWS,CRM/PSS,QMHA-R)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:AMOS
Last Name:SHELLBE
Suffix:
Gender:M
Credentials:PWS,CRM/PSS,QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34272 BACHELOR FLAT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-3710
Mailing Address - Country:US
Mailing Address - Phone:503-396-2826
Mailing Address - Fax:
Practice Address - Street 1:34272 BACHELOR FLAT RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-3710
Practice Address - Country:US
Practice Address - Phone:503-396-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-2258175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist