Healthcare Provider Details

I. General information

NPI: 1750453031
Provider Name (Legal Business Name): SHIRLEY A WEBSTER MFT, LADC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 LAKESHORE DRIVE HTN
WASHOE VALLEY NV
89704
US

IV. Provider business mailing address

3275 LAKE SHORE DR
WASHOE VALLEY NV
89704-9249
US

V. Phone/Fax

Practice location:
  • Phone: 775-849-3434
  • Fax: 775-849-3435
Mailing address:
  • Phone: 775-849-3434
  • Fax: 775-849-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number137
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: