Healthcare Provider Details

I. General information

NPI: 1992825996
Provider Name (Legal Business Name): SHAYLA D WELLS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ALAMEDA ST
NORMAN OK
73071-5229
US

IV. Provider business mailing address

1701 HAZELWOOD DR
NORMAN OK
73071-1943
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-3980
  • Fax:
Mailing address:
  • Phone: 405-364-4819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3042
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: