Provider Demographics
NPI:1225508617
Name:WARE, SHELLEY M (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:M
Last Name:WARE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-5041
Mailing Address - Country:US
Mailing Address - Phone:774-535-2804
Mailing Address - Fax:
Practice Address - Street 1:1513 S 31ST ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-5041
Practice Address - Country:US
Practice Address - Phone:774-535-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222336104100000X
MA1224471041C0700X
RICSW023571041C0700X
OK71901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker