Individual
MISS SHELLEY ANNE FASSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
245 N CENTENNIAL WAY, MESA, AZ 85201
(602) 290-0278
Mailing address
245 N CENTENNIAL WAY, MESA, AZ 85201-6702
(602) 290-0278
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW17127
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
373998
—
AZ
Enumeration date
04/29/2010
Last updated
06/04/2018
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