Provider Demographics
NPI:1447676671
Name:FEY, SHELBY N (BCBA, LPC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:N
Last Name:FEY
Suffix:
Gender:F
Credentials:BCBA, LPC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:N
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4110 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3758
Mailing Address - Country:US
Mailing Address - Phone:810-300-8592
Mailing Address - Fax:
Practice Address - Street 1:51145 NICOLETTE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4585
Practice Address - Country:US
Practice Address - Phone:248-569-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014846101YM0800X
MI146N00000X
MI1-18-32560103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic