Provider Demographics
NPI:1104022763
Name:MCNEILL, SHELLEY D (MSHR)
Entity Type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:D
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:MSHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11823 PRAIRIE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-6326
Mailing Address - Country:US
Mailing Address - Phone:580-504-5700
Mailing Address - Fax:
Practice Address - Street 1:11823 PRAIRIE VALLEY RD
Practice Address - Street 2:
Practice Address - City:LONE GROVE
Practice Address - State:OK
Practice Address - Zip Code:73443-6326
Practice Address - Country:US
Practice Address - Phone:580-504-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor