Provider Demographics
NPI:1831340041
Name:CUMBERLEDGE, SHELLY RENEE (CPRSS)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:RENEE
Last Name:CUMBERLEDGE
Suffix:
Gender:F
Credentials:CPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-4446
Mailing Address - Country:US
Mailing Address - Phone:580-276-3323
Mailing Address - Fax:580-276-3324
Practice Address - Street 1:404 E. PINE ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448
Practice Address - Country:US
Practice Address - Phone:580-276-3323
Practice Address - Fax:580-276-3324
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health