Provider Demographics
NPI:1922433143
Name:HARRIS, SHELBY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 ARLINGTON ST STE G
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4072
Mailing Address - Country:US
Mailing Address - Phone:580-332-6851
Mailing Address - Fax:580-310-6047
Practice Address - Street 1:101 W 5TH ST.
Practice Address - Street 2:
Practice Address - City:WRIGHT CITY
Practice Address - State:OK
Practice Address - Zip Code:74766
Practice Address - Country:US
Practice Address - Phone:580-981-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100750190LMedicaid