Provider Demographics
NPI:1154735678
Name:HORINE, SHELLEY (LPC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:HORINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26471 SOUTHPOINT RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1371
Mailing Address - Country:US
Mailing Address - Phone:419-482-8382
Mailing Address - Fax:
Practice Address - Street 1:26471 SOUTHPOINT RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1371
Practice Address - Country:US
Practice Address - Phone:419-482-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health