Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003255704 |
---|---|
Provider Name | Krissie L Shells |
First Address | Marion, AR 72364-1936 |
Second Address | Marion, AR 72364-1936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 17/06/2013 |