Healthcare Provider Details

I. General information

NPI: 1730784760
Provider Name (Legal Business Name): SHELBY LYNN BECKMAN SMITH LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 N LEROY ST UNIT 3060
FENTON MI
48430-2758
US

IV. Provider business mailing address

1114 N LEROY ST UNIT 3060
FENTON MI
48430-2758
US

V. Phone/Fax

Practice location:
  • Phone: 810-215-0122
  • Fax:
Mailing address:
  • Phone: 810-215-0122
  • Fax: 989-286-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018748
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: