=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114225828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHELLEY S. BERVEN AND ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2011
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 595 SELBY AVE
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55102-1730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-293-3923
-----------------------------------------------------
Fax | 612-465-4017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 774 DELAWARE AVE
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55107-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-269-9761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHELLEY SEARS BERVEN
-----------------------------------------------------
Credential | MSW, LICSW
-----------------------------------------------------
Telephone | 651-293-3923
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 06845
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------