Provider Demographics
NPI:1376819953
Name:SHEA, KELLY DIANNE (LMFT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:DIANNE
Last Name:SHEA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-1126
Mailing Address - Country:US
Mailing Address - Phone:641-373-1375
Mailing Address - Fax:
Practice Address - Street 1:515 N RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1126
Practice Address - Country:US
Practice Address - Phone:641-373-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist