Healthcare Provider Details

I. General information

NPI: 1770814998
Provider Name (Legal Business Name): MARCUS E SHIPP BSHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 NW 161ST ST
EDMOND OK
73013-1299
US

IV. Provider business mailing address

2421 NW161ST STREET
EDMOND OK
73013-1299
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-8757
  • Fax:
Mailing address:
  • Phone: 405-726-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: