MEDICARE: SHELBY TAYLOR-GOALBY MA, LPC, CADC I

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		OR

General Provider Information

NPI Number	:	1699968123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY TAYLOR-GOALBY MA, LPC, CADC I

Provider Business Mailing Address
First Line	:	13500 SW PACIFIC HWY # 212
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-4804
Country	:	US
Telephone Number	:	503-245-5977
Fax Number	:

Provider Business Practice Location Address
First Line	:	9860 SW HALL BLVD
Second Line	:	SUITE D
City	:	TIGARD
State	:	OR
Zip	:	97223-8896
Country	:	US
Telephone Number	:	503-245-5977
Fax Number	:

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

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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