Provider Demographics
NPI:1982198784
Name:SPEAR, SHELBIE (DTLLP)
Entity Type:Individual
Prefix:
First Name:SHELBIE
Middle Name:
Last Name:SPEAR
Suffix:
Gender:F
Credentials:DTLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 CRESCENT ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3501
Mailing Address - Country:US
Mailing Address - Phone:231-571-0205
Mailing Address - Fax:
Practice Address - Street 1:4690 FULTON ST E STE 102
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8454
Practice Address - Country:US
Practice Address - Phone:616-425-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist