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SHELLY ROSE VONK STALEY LMFT 114352
NPI 1801264932
Marriage & Family Therapist in San Luis Obispo, CA

Active since September 06, 2015Opted out of Medicare · through Jan 1, 2028
PMB 277, 3940-7 BROAD STREET, SAN LUIS OBISPO, CA 93401(805) 215-3738 Get Directions Write a Review

NPPES record last updated: October 7, 2021. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Oct 7, 2021, Apr 2, 2020, Aug 9, 2019 and 1 more (4 updates tracked since 2018).

About Shelly Rose Vonk Staley Lmft 114352 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELLY ROSE VONK STALEY LMFT 114352 (NPI 1801264932) is an individual marriage & family therapist in San Luis Obispo, California, licensed in California (LMFT114352) and active in the NPI registry since September 2015. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1801264932
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameSHELLY ROSE VONK STALEYCredential: LMFT 114352
Location AddressPMB 277, 3940-7 BROAD STREETSan Luis Obispo, CA 93401
Mailing AddressPmb 277, 3940-7 Broad StreetSan Luis Obispo, CA 93401 · (805) 215-3738
Phone(805) 215-3738
Sole ProprietorYes
Enumeration DateSeptember 6, 2015
Last NPPES UpdateOctober 7, 20214 updates tracked since enumeration
NPPES CertifiedOctober 7, 2021
✔ NPI 1801264932 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · LMFT114352
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
PMB 277, San Luis Obispo, CA 93401
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Other Names 1

Former Name (1)Shelly Rose Vonk

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Shelly Rose Vonk Staley Lmft 114352 has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shelly Staley's NPI number?

The NPI number for Shelly Staley is 1801264932. It was assigned to this individual provider in the NPPES registry on September 6, 2015. The provider is also known as Shelly Rose Vonk.

Where is Shelly Staley located?

Shelly Staley practices at Pmb 277 3940-7 Broad Street, San Luis Obispo, CA 93401. The listed phone number is (805) 215-3738.

What is Shelly Staley's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Shelly Staley enrolled in Medicare?

No. Shelly Staley has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Shelly Staley was last updated on October 7, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.