Healthcare Provider Details

I. General information

NPI: 1700628674
Provider Name (Legal Business Name): SHELBY BETHEL LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 CHURCH ST
WHITINSVILLE MA
01588-1464
US

IV. Provider business mailing address

76 CHURCH ST
WHITINSVILLE MA
01588-1464
US

V. Phone/Fax

Practice location:
  • Phone: 508-234-4181
  • Fax:
Mailing address:
  • Phone: 508-234-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7398
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: