Provider Demographics
NPI:1053532614
Name:SMITHSON, SHELLEY BEA (PHD, MSW)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:BEA
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-332-0231
Mailing Address - Fax:
Practice Address - Street 1:1675 WATERPOWER PLACE
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6399
Practice Address - Country:US
Practice Address - Phone:517-332-1562
Practice Address - Fax:517-993-5200
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006305103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist