Healthcare Provider Details

I. General information

NPI: 1831053354
Provider Name (Legal Business Name): SHELBIE BOUCK LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N 100 E STE 8
ST GEORGE UT
84770-2505
US

IV. Provider business mailing address

369 N 2480 W
HURRICANE UT
84737-3511
US

V. Phone/Fax

Practice location:
  • Phone: 435-216-0909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12821981-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: