Healthcare Provider Details

I. General information

NPI: 1346133071
Provider Name (Legal Business Name): SHELBY WILLIAMS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 FULTON ST E STE 2
GRAND RAPIDS MI
49503-3562
US

IV. Provider business mailing address

929 FULTON ST E STE 2
GRAND RAPIDS MI
49503-3562
US

V. Phone/Fax

Practice location:
  • Phone: 231-288-2092
  • Fax:
Mailing address:
  • Phone: 231-288-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHELBY KATHERINE WILLIAMS
Title or Position: OWNER, PSYCHOTHERAPIST
Credential: LMSW
Phone: 231-288-2092