Provider Demographics
NPI:1326285974
Name:MADDEN, SHELLEY L (MSCP)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:L
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 EASTVALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6833
Mailing Address - Country:US
Mailing Address - Phone:405-250-8897
Mailing Address - Fax:
Practice Address - Street 1:416 SW 79TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8121
Practice Address - Country:US
Practice Address - Phone:405-246-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-18
Last Update Date:2009-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional