Healthcare Provider Details

I. General information

NPI: 1003255704
Provider Name (Legal Business Name): KRISSIE L SHELLS MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 MANOR ST
MARION AR
72364-1936
US

IV. Provider business mailing address

252 MANOR ST
MARION AR
72364-1936
US

V. Phone/Fax

Practice location:
  • Phone: 870-739-6818
  • Fax: 870-739-6821
Mailing address:
  • Phone: 870-739-6818
  • Fax: 870-739-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: