Provider Demographics
NPI:1790911659
Name:POLK, SHIRLEY HENDERSON (BSN-MSN-LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:HENDERSON
Last Name:POLK
Suffix:
Gender:F
Credentials:BSN-MSN-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5446 E EXETER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:602-957-1119
Mailing Address - Fax:
Practice Address - Street 1:6991 E CAMELBACK RD
Practice Address - Street 2:SUITE #B360
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-429-9044
Practice Address - Fax:480-429-9048
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZDBHS #CC0545101YA0400X
AZRN015602163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)