Individual
KELLY SHORES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMFT, LAC
Contact information
Practice address
415 W BROADWAY ST, FORTVILLE, IN 46040-1462
(317) 710-7772
Mailing address
415 W BROADWAY ST, FORTVILLE, IN 46040-1462
(317) 710-7772
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35001781A
IN
Other
Enumeration date
03/12/2019
Last updated
03/12/2019
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