Provider Demographics
NPI:1740068048
Name:SHELLY WIEWIORA LLC
Entity type:Organization
Organization Name:SHELLY WIEWIORA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEWIORA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:231-286-6077
Mailing Address - Street 1:433 SEMINOLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3743
Mailing Address - Country:US
Mailing Address - Phone:231-286-6077
Mailing Address - Fax:
Practice Address - Street 1:433 SEMINOLE RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3743
Practice Address - Country:US
Practice Address - Phone:231-286-6077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty