Provider Demographics
NPI:1962284539
Name:LEVY, SHELBY ANN
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SE 28TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4268
Mailing Address - Country:US
Mailing Address - Phone:479-644-7413
Mailing Address - Fax:479-876-8636
Practice Address - Street 1:809 SE 28TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4268
Practice Address - Country:US
Practice Address - Phone:479-644-7413
Practice Address - Fax:479-876-8636
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2310015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health