Provider Demographics
NPI:1861077893
Name:SOWELL, SHELLY R (LPCC)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:R
Last Name:SOWELL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WALLACE AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3060
Mailing Address - Country:US
Mailing Address - Phone:502-396-0879
Mailing Address - Fax:
Practice Address - Street 1:317 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3060
Practice Address - Country:US
Practice Address - Phone:502-396-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health