Healthcare Provider Details

I. General information

NPI: 1699606756
Provider Name (Legal Business Name): MELANGEL SABLE FAWN SHELLENBARGER TLMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 KIMBERLY RD STE 270
BETTENDORF IA
52722-3509
US

IV. Provider business mailing address

2435 KIMBERLY RD STE 270
BETTENDORF IA
52722-3509
US

V. Phone/Fax

Practice location:
  • Phone: 563-265-5201
  • Fax:
Mailing address:
  • Phone: 563-265-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138956
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: