Provider Demographics
NPI:1720529977
Name:BRIGGS, SHELBY (LADC, CCS)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4638
Mailing Address - Country:US
Mailing Address - Phone:207-408-3846
Mailing Address - Fax:
Practice Address - Street 1:11 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4638
Practice Address - Country:US
Practice Address - Phone:207-408-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6104101YA0400X
MELC6578101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAIMedicaid