Individual
SHELLEY M FENTRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
(270) 234-8572
Mailing address
HC 72 BOX 250, UNION STAR, KY 40171-9716
(270) 496-4737
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
KY-0412
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000530500
ANTHEM
KY
05
—
30605018
—
KY
Enumeration date
01/29/2007
Last updated
11/22/2010
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