Provider Demographics
NPI:1619981867
Name:KELLEY, SHAWN L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:L
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-7024
Mailing Address - Country:US
Mailing Address - Phone:580-223-3070
Mailing Address - Fax:580-242-4679
Practice Address - Street 1:1625 W OWEN K GARRIOTT RD
Practice Address - Street 2:SUITE F
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5653
Practice Address - Country:US
Practice Address - Phone:580-242-4673
Practice Address - Fax:580-242-4679
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical