Provider Demographics
NPI:1104955210
Name:TAIT, SHELLEY (LMFT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:TAIT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 N LLOYD BUSH DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9527
Mailing Address - Country:US
Mailing Address - Phone:520-743-1999
Mailing Address - Fax:520-618-2905
Practice Address - Street 1:607 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-8300
Practice Address - Country:US
Practice Address - Phone:520-743-1999
Practice Address - Fax:520-618-2905
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0386106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist