MEDICARE: SHELLY L WHITNEY LCSW

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
1	101YM0800X	Mental Health Counselor	CSW.09925174	CO

General Provider Information

NPI Number	:	1306308911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY L WHITNEY LCSW

Provider Business Mailing Address
First Line	:	1325 S COLORADO BLVD STE 604
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3323
Country	:	US
Telephone Number	:	720-936-6921
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S COLORADO BLVD STE 604
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3323
Country	:	US
Telephone Number	:	720-936-6921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	04/02/2019

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