Healthcare Provider Details

I. General information

NPI: 1801700034
Provider Name (Legal Business Name): SHELLY SHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RAWLS DR STE E
MCCOMB MS
39648-2816
US

IV. Provider business mailing address

300 RAWLS DR STE E
MCCOMB MS
39648-2816
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-8284
  • Fax: 601-684-8199
Mailing address:
  • Phone: 601-684-8284
  • Fax: 601-684-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: