Healthcare Provider Details

I. General information

NPI: 1174041503
Provider Name (Legal Business Name): SHELBY ROSE CANTLEY LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 HAYES AVE
SANDUSKY OH
44870-4737
US

IV. Provider business mailing address

1925 HAYES AVE
SANDUSKY OH
44870-4737
US

V. Phone/Fax

Practice location:
  • Phone: 419-557-5162
  • Fax: 419-557-5179
Mailing address:
  • Phone: 419-557-5177
  • Fax: 419-557-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1700647
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1901563
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: