Provider Demographics
NPI:1831353127
Name:CLINGAN, SHELLEY DIANE (BSW, MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DIANE
Last Name:CLINGAN
Suffix:
Gender:F
Credentials:BSW, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 W CLYDESDALE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-8209
Mailing Address - Country:US
Mailing Address - Phone:479-444-1670
Mailing Address - Fax:479-444-1675
Practice Address - Street 1:885 W CLYDESDALE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-8209
Practice Address - Country:US
Practice Address - Phone:479-444-1670
Practice Address - Fax:479-444-1675
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2094-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical