=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205646973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELBY ARMSTRONG MFT-INTERN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10655 PARK RUN DR STE 210
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89144-4590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-533-0722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8348 WINTERCHASE PL
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89143-6414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-340-2575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MI4431
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------