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General NPI Number Information
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NPI Number | 1457051435
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Entity Type | Individual
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Provider Name | KRISTEN SHORTELL MS, LPC, LPAT ATR-BC
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Gender | Female
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 39 AVENUE AT THE CMN STE 106
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4560
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Country | US
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Telephone | 732-378-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 774 NEWMAN SPRINGS RD UNIT 327
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City | LINCROFT
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State | NJ
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Zip | 07738-8012
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Country | US
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Telephone | 732-378-9314
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 16LP00009600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00846900
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License Number State | NJ
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