Provider Demographics
NPI:1790349991
Name:CULLEY, SHIRLEY
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:CULLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:DENISE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-0427
Mailing Address - Country:US
Mailing Address - Phone:580-798-4523
Mailing Address - Fax:580-319-5349
Practice Address - Street 1:1219 K ST NW STE 2
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1801
Practice Address - Country:US
Practice Address - Phone:580-798-4523
Practice Address - Fax:580-319-5349
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician