Provider Demographics
NPI:1104286103
Name:GORET, SHELBI RHEA (LSAA)
Entity type:Individual
Prefix:
First Name:SHELBI
Middle Name:RHEA
Last Name:GORET
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 EAGLE RANCH RD NW
Mailing Address - Street 2:APT 1723
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6033
Mailing Address - Country:US
Mailing Address - Phone:575-418-7712
Mailing Address - Fax:
Practice Address - Street 1:1528 FIVE POINTS RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3179
Practice Address - Country:US
Practice Address - Phone:505-242-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0172751101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)