Provider Demographics
NPI:1154615284
Name:NIELSON, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:NIELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 S LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2225
Mailing Address - Country:US
Mailing Address - Phone:385-347-9050
Mailing Address - Fax:
Practice Address - Street 1:174 S LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-2225
Practice Address - Country:US
Practice Address - Phone:385-347-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11757088-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health