Healthcare Provider Details

I. General information

NPI: 1053072520
Provider Name (Legal Business Name): SHELBI RAELYNNE GABBARD LMHCA, ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBI RAELYNNE TIDD

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 3 MILE RD NW
GRAND RAPIDS MI
49544-1425
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 616-222-3720
  • Fax: 616-222-3724
Mailing address:
  • Phone: 616-455-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004402A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6352001211
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88001233A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: