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General NPI Number Information
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NPI Number | 1407738156
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Entity Type | Individual
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Provider Name | SHELLY MARIE DONALDSON
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Gender | Female
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 498 N 900 W STE 220
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City | KAYSVILLE
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State | UT
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Zip | 84037-4189
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Country | US
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Telephone | 801-525-4645
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Fax |
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Provider Business Mailing Address
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Address Line | 9155 GEORGE WASHINGTON MEMORIAL HWY
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City | GLOUCESTER
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State | VA
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Zip | 23061-4174
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Country | US
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Telephone | 734-634-3174
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13038895-6004
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License Number State | UT
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