Provider Demographics
NPI:1003787045
Name:KELLEHER, SHIHO CHARLENE
Entity type:Individual
Prefix:MS
First Name:SHIHO
Middle Name:CHARLENE
Last Name:KELLEHER
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 1:1703 WHITEHALL DR UNIT 2C
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-2540
Mailing Address - Country:US
Mailing Address - Phone:720-217-9508
Mailing Address - Fax:
Practice Address - Street 1:1703 WHITEHALL DR UNIT 2C
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-2540
Practice Address - Country:US
Practice Address - Phone:720-217-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103TS0200X
ID103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool