| Doctor Name: | SHELLY RAE EHMANN |
| NPI Number: | 1083841928 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MC, LPC |
| License Number: | LPC-2472 |
| Business Practice Address: | 105 N 5th Ave Holbrook, AZ - 860252817 |
| Business Phone Number: | 9285246126 |
| Business Fax Number: | |
| Mailing Address: | 2832 View Way, LAKESIDE |
| State: | AZ |
| Postal Code: | 859295549 |
| Phone Number: | 9282428729 |
| Fax Number: | 9283688720 |
| NPI Enumeration Date: | 06/18/2009 |
| NPI Last Update Date: | 06/18/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC-2472 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |