Provider Demographics
NPI:1356809701
Name:SHELEY, BETHANY FAITH (MED)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:FAITH
Last Name:SHELEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:BETHANY
Other - Middle Name:FAITH
Other - Last Name:SHELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:10531 EAST RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-9730
Mailing Address - Country:US
Mailing Address - Phone:605-319-9076
Mailing Address - Fax:
Practice Address - Street 1:169 MASON ST STE 300
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4483
Practice Address - Country:US
Practice Address - Phone:707-463-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker