Provider Demographics
NPI:1144946120
Name:SHELBURN, KAILEY BETH
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:BETH
Last Name:SHELBURN
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 1:2002 W CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5431
Mailing Address - Country:US
Mailing Address - Phone:210-771-2554
Mailing Address - Fax:
Practice Address - Street 1:2525 W CAREFREE HWY STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-9302
Practice Address - Country:US
Practice Address - Phone:210-771-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-7494T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health