=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194425900
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELBY BALDWIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2023
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98 E LAKE MEAD PKWY STE 201
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89015-6443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-433-3038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4505 PARADISE RD APT 2306
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89169-7110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-317-4598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CP6015
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------