Provider Demographics
NPI:1992002406
Name:MACKLEY, SHIRLEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:MACKLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 NEW BRIDGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17368-9052
Mailing Address - Country:US
Mailing Address - Phone:717-880-8517
Mailing Address - Fax:
Practice Address - Street 1:194 NEW BRIDGEVILLE RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17368-9052
Practice Address - Country:US
Practice Address - Phone:717-880-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001000101YP2500X
PAPS 017048103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional