Provider Demographics
NPI:1790347573
Name:SHIRLEY, WILFRED (SUBSTANCE ABUSE COUN)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:SUBSTANCE ABUSE COUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7072
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-7072
Mailing Address - Country:US
Mailing Address - Phone:928-657-8000
Mailing Address - Fax:928-657-8009
Practice Address - Street 1:1/2 MILE NORTHEAST DILKON BASHAS STORE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047
Practice Address - Country:US
Practice Address - Phone:928-657-8000
Practice Address - Fax:928-657-8009
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)