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NPI Code Detail

MEDICARE: SHELLY L ELLINGBOE LPC

MEDICARE: SHELLY L ELLINGBOE LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor6401005225MI

General Provider Information

NPI Number : 1295468916
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLY L ELLINGBOE LPC
Provider Business Mailing Address
First Line : 17892 WOODCREEK LN
Second Line :
City : SPRING LAKE
State : MI
Zip : 49456-9239
Country : US
Telephone Number : 616-260-1471
Fax Number :
Provider Business Practice Location Address
First Line : 3611 HENRY ST
Second Line :
City : NORTON SHORES
State : MI
Zip : 49441-4705
Country : US
Telephone Number : 231-237-8898
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2022
Last Update Date : 07/09/2022

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Directions to “ SHELLY L ELLINGBOE LPC” Practice Location

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