Healthcare Provider Details

I. General information

NPI: 1609453232
Provider Name (Legal Business Name): SHELBY ELAINE STONEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W STOLL RD APT B
DEWITT MI
48820-8614
US

IV. Provider business mailing address

1501 W STOLL RD APT B
DEWITT MI
48820-8614
US

V. Phone/Fax

Practice location:
  • Phone: 989-708-2420
  • Fax:
Mailing address:
  • Phone: 989-708-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: