MEDICARE: MICHAEL THOMAS SHELEY

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	127786	CA
2	104100000X	Social Worker	127786	CA
3	1041C0700X	Clinical Social Worker	127786	CA
4	225400000X	Rehabilitation Practitioner
5	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1760093942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL THOMAS SHELEY

Provider Business Mailing Address
First Line	:	3212 NEBRASKA AVE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-4214
Country	:	US
Telephone Number	:	310-744-1310
Fax Number	:	310-751-5543

Provider Business Practice Location Address
First Line	:	3212 NEBRASKA AVE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-4214
Country	:	US
Telephone Number	:	310-744-1310
Fax Number	:	310-751-5543

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

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	02/17/2026

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