=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487951265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY SHIPMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2011
-----------------------------------------------------
Last Update Date | 03/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12383 ELIZABETH DR
-----------------------------------------------------
City | MIDWEST CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73130-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-615-9272
-----------------------------------------------------
Fax | 405-610-2162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12383 ELIZABETH DR
-----------------------------------------------------
City | MIDWEST CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73130-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-615-9272
-----------------------------------------------------
Fax | 405-610-2162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 4706
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------