Healthcare Provider Details

I. General information

NPI: 1194425900
Provider Name (Legal Business Name): SHELBY BALDWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY STE 201
HENDERSON NV
89015-6443
US

IV. Provider business mailing address

4505 PARADISE RD APT 2306
LAS VEGAS NV
89169-7110
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-3038
  • Fax:
Mailing address:
  • Phone: 907-317-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP6015
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: