Provider Demographics
NPI:1386078871
Name:CURTIS, SHELLY (BA, SUDP)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:BA, SUDP
Other - Prefix:MS
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:HADALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, CDP
Mailing Address - Street 1:1520 KELLY PL
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8607
Mailing Address - Country:US
Mailing Address - Phone:509-524-2998
Mailing Address - Fax:
Practice Address - Street 1:1520 KELLY PL
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8607
Practice Address - Country:US
Practice Address - Phone:509-524-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WACP60644176101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator