Healthcare Provider Details

I. General information

NPI: 1659806495
Provider Name (Legal Business Name): THERAPY SERVICES WITH SHELLEY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 4TH ST S
MOORHEAD MN
56560-3322
US

IV. Provider business mailing address

820 4TH ST S
MOORHEAD MN
56560-3322
US

V. Phone/Fax

Practice location:
  • Phone: 218-329-6294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2009-027
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1264
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DAHL MONROE
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 218-329-6294