Provider Demographics
NPI:1912216037
Name:HOUSE, SHIRLEY MARIE (BHRS)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 N. CLASSEN, SUITE 159
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118
Mailing Address - Country:US
Mailing Address - Phone:405-607-6670
Mailing Address - Fax:
Practice Address - Street 1:4801 N CLASSEN BLVD STE 159
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4618
Practice Address - Country:US
Practice Address - Phone:405-607-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation