Healthcare Provider Details

I. General information

NPI: 1225654015
Provider Name (Legal Business Name): ANDREA L SHIRLEY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11250 E STATE ROUTE 69 LOT 1125
PRESCOTT VALLEY AZ
86327-4405
US

IV. Provider business mailing address

11250 E STATE ROUTE 69 LOT 1125
PRESCOTT VALLEY AZ
86327-4405
US

V. Phone/Fax

Practice location:
  • Phone: 602-487-6777
  • Fax:
Mailing address:
  • Phone: 602-487-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: