Provider Demographics
NPI:1093427262
Name:POOLE, SHELLI ANN (P-LPC, NCC, M ED)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:ANN
Last Name:POOLE
Suffix:
Gender:F
Credentials:P-LPC, NCC, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E WELLSGATE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5952
Mailing Address - Country:US
Mailing Address - Phone:662-816-8171
Mailing Address - Fax:
Practice Address - Street 1:2690 W OXFORD LOOP STE 146
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5575
Practice Address - Country:US
Practice Address - Phone:662-304-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health