Healthcare Provider Details

I. General information

NPI: 1851777239
Provider Name (Legal Business Name): SHELLY JEAN BLANCHARD MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E BRADFORD PKWY STE 305
SPRINGFIELD MO
65804-6539
US

IV. Provider business mailing address

1531 E BRADFORD PKWY STE 305
SPRINGFIELD MO
65804-6539
US

V. Phone/Fax

Practice location:
  • Phone: 563-422-8472
  • Fax:
Mailing address:
  • Phone: 563-422-8472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2024048329
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: