Shelly Denise Minor, PH.D
Individual provider Active NPI Psychologist · Bethel Island, CA
NPI 1891977435 · NPPES record last updated Feb 17, 2011
Key facts
- NPI
- 1891977435
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 21477 (CA)
- Practice address
- 6327 Bethel Island Road
Suite a
Bethel Island, CA 94511-1011 - Phone
- (925) 550-0540
- Fax
- (925) 684-0348
- NPI assigned
- Dec 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2004
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
6327 Bethel Island Rd
Suite a
Bethel Island, CA 94511-1011
Phone (925) 550-0540
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110525000662 | CA | Practitioner - Clinical Psychologist | 8729264882 | Practice locations: Bethel Island, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21477 | CA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 21477 | CA | Yes |
Addresses
Primary practice location
6327 Bethel Island Road
Suite a
Bethel Island, CA 94511-1011
Mailing address
6327 Bethel Island Road Suite a
Bethel Island, CA 94511
Phone (925) 550-0540
Other names
- Ms. Shelly Denise Carpenter
Other providers in Bethel Island, CA
- Cityserve Network
- Fownd Inc
- New Life Dream Center
- Jennifer Leneigh Ortega
- Prevailing Winds International
All providers in Bethel Island, CA · Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.