Provider Demographics
NPI:1982841458
Name:CRESPO, SHELBY LEE (ND, LCSW, LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:LEE
Last Name:CRESPO
Suffix:
Gender:F
Credentials:ND, LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 BARKER DR
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9480
Mailing Address - Country:US
Mailing Address - Phone:810-210-2509
Mailing Address - Fax:
Practice Address - Street 1:4111 BARKER DR
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9480
Practice Address - Country:US
Practice Address - Phone:810-210-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010854491041C0700X
IL1490183291041C0700X
OR4385175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical