Provider Demographics
NPI:1659836229
Name:KOERNER, SHELBY (LMHC, LPCC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:KOERNER
Suffix:
Gender:F
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 DANDELION TRL
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9129
Mailing Address - Country:US
Mailing Address - Phone:585-402-6662
Mailing Address - Fax:
Practice Address - Street 1:3315 DANDELION TRL
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9129
Practice Address - Country:US
Practice Address - Phone:585-402-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2807101YM0800X
NY008160-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health