Provider Demographics
NPI:1780454256
Name:SHELLEY RORVICK LLC
Entity type:Organization
Organization Name:SHELLEY RORVICK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RORVICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:218-409-6456
Mailing Address - Street 1:302 WEST SUPERIOR STREET
Mailing Address - Street 2:508 LONSDALE BUILDING
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-5115
Mailing Address - Country:US
Mailing Address - Phone:218-409-6456
Mailing Address - Fax:
Practice Address - Street 1:302 WEST SUPERIOR STREET
Practice Address - Street 2:508 LONSDALE BUILDING
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-5115
Practice Address - Country:US
Practice Address - Phone:218-409-6456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063896355OtherNPI 1