Healthcare Provider Details

I. General information

NPI: 1972429512
Provider Name (Legal Business Name): SHELBY PERKINS PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E WASHINGTON AVE APT 713
MADISON WI
53703-4413
US

IV. Provider business mailing address

1010 E WASHINGTON AVE APT 713
MADISON WI
53703-4413
US

V. Phone/Fax

Practice location:
  • Phone: 847-346-6561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHELBY PERKINS
Title or Position: OWNER
Credential:
Phone: 847-346-6561