Provider Demographics
NPI:1538149489
Name:DAUD, SHELLY (LPE)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:
Last Name:DAUD
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 PRINCE ST
Mailing Address - Street 2:APT. # 27
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3637
Mailing Address - Country:US
Mailing Address - Phone:501-329-1329
Mailing Address - Fax:
Practice Address - Street 1:2526 HIGHWAY 65 S
Practice Address - Street 2:SUITE 202
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6588
Practice Address - Country:US
Practice Address - Phone:501-329-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR98-12E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health