Healthcare Provider Details

I. General information

NPI: 1124813068
Provider Name (Legal Business Name): SHELBY JAMES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 S BEARFIELD RD
COLUMBIA MO
65201-9557
US

IV. Provider business mailing address

1814 HATTON DR
COLUMBIA MO
65203-1904
US

V. Phone/Fax

Practice location:
  • Phone: 844-424-3577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2025022523
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: