Healthcare Provider Details

I. General information

NPI: 1477959666
Provider Name (Legal Business Name): SHELLEY ALVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY BAYLY

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 CHANATE RD
SANTA ROSA CA
95404-1708
US

IV. Provider business mailing address

139 WINDSOR PALMS DR
WINDSOR CA
95492-8094
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-8181
  • Fax:
Mailing address:
  • Phone: 707-529-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: