Healthcare Provider Details

I. General information

NPI: 1356809701
Provider Name (Legal Business Name): BETHANY FAITH SHELEY M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY FAITH SHELEY M.ED.

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MASON ST STE 300
UKIAH CA
95482-4483
US

IV. Provider business mailing address

10531 EAST RD
REDWOOD VALLEY CA
95470-9730
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-3300
  • Fax:
Mailing address:
  • Phone: 605-319-9076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: