Healthcare Provider Details

I. General information

NPI: 1104044726
Provider Name (Legal Business Name): FRANCIS M SHELTON EDD,PSRS,CM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57523 MOCCASIN TRL
PRAGUE OK
74864-1046
US

IV. Provider business mailing address

125 SOUTH PECAN
BOLEY OK
74829
US

V. Phone/Fax

Practice location:
  • Phone: 405-567-3202
  • Fax: 405-567-0054
Mailing address:
  • Phone: 918-667-3477
  • Fax: 918-667-3622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10196
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: