Healthcare Provider Details

I. General information

NPI: 1407722010
Provider Name (Legal Business Name): SHELBY VANSCOYOC LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 E CENTER ST
ITHACA MI
48847-1603
US

IV. Provider business mailing address

8796 15 MILE RD
EVART MI
49631-8380
US

V. Phone/Fax

Practice location:
  • Phone: 989-875-5101
  • Fax:
Mailing address:
  • Phone: 231-388-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024524
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: