Healthcare Provider Details

I. General information

NPI: 1104190354
Provider Name (Legal Business Name): ELIZABETH GIVENS SHIREY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W HIGH ST
BELLEFONTE PA
16823
US

IV. Provider business mailing address

317 WEST PROSPECT AVENUE
STATE COLLEGE PA
16801-4617
US

V. Phone/Fax

Practice location:
  • Phone: 814-353-3151
  • Fax: 814-353-1876
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005692L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: