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General NPI Number Information
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NPI Number | 1023340932
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Entity Type | Individual
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Provider Name | MS. SHELLY KAY STEPHENS
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Gender | Female
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 350 E GOBBI ST
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City | UKIAH
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State | CA
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Zip | 95482-5511
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Country | US
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Telephone | 707-472-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 33680 HIGHWAY 128 #4
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City | CLOVERDALE
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State | CA
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Zip | 95425-9431
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Country | US
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Telephone | 707-472-2922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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