Individual
SHELLY WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SW
Contact information
Practice address
1759 BROAD PARK CIR S STE 113, MANSFIELD, TX 76063-7836
(817) 473-1312
Mailing address
1759 BROAD PARK CIR S STE 113, MANSFIELD, TX 76063-7836
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
16681
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
482228
PTAN
TX
Enumeration date
11/10/2020
Last updated
11/10/2020
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