Healthcare Provider Details

I. General information

NPI: 1013927060
Provider Name (Legal Business Name): SHELLY R WILLIAMS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLY TRIMBLE LISW-S, LCSW

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 110098
PALM BAY FL
32911-0098
US

IV. Provider business mailing address

PO BOX 110098
PALM BAY FL
32911-0098
US

V. Phone/Fax

Practice location:
  • Phone: 214-382-3197
  • Fax: 214-382-3198
Mailing address:
  • Phone: 214-382-3197
  • Fax: 214-381-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0500072
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113151
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: