Provider Demographics
NPI:1700687134
Name:LEE, SHELBY LYNN
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LYNN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:LYNN
Other - Last Name:COY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OR
Mailing Address - Zip Code:97033-0357
Mailing Address - Country:US
Mailing Address - Phone:541-300-9196
Mailing Address - Fax:
Practice Address - Street 1:121 SW SALMON ST FL 11
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2908
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10253816103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst