Provider Demographics
NPI:1215245832
Name:ACIERNO, SHELLEY (LMFT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:ACIERNO
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 1:31700 TELEGRAPH RD STE 230
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3466
Mailing Address - Country:US
Mailing Address - Phone:248-952-8332
Mailing Address - Fax:
Practice Address - Street 1:31700 TELEGRAPH RD STE 230
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-952-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006550106H00000X
IL166.000883106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist