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Individual

THERESA SHELLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
55 BASIN CREEK RD, BUTTE, MT 59701-9704
(406) 496-6314
(406) 494-1724
Mailing address
2025 MULLAN RD APT 105, MISSOULA, MT 59808-2110
(406) 745-3811
(406) 745-4070

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2231
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1477745370
MT
Enumeration date
07/23/2012
Last updated
07/23/2012
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