Provider Demographics
NPI:1922240936
Name:KIRKMAN, SHELIA ROSE (MS)
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:ROSE
Last Name:KIRKMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 W COUNTY ROAD 600 N
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-8234
Mailing Address - Country:US
Mailing Address - Phone:812-605-2068
Mailing Address - Fax:
Practice Address - Street 1:965 W CRAIG AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-7400
Practice Address - Country:US
Practice Address - Phone:812-446-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001081A101YM0800X
IN34003195A1041C0700X
IN35000028A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical