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General NPI Number Information
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NPI Number | 1619496858
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Entity Type | Individual
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Provider Name | SHELBY K MULDER
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Gender | Female
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 13327 E 33RD PL
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City | TULSA
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State | OK
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Zip | 74134-4015
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Country | US
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Telephone | 918-280-9072
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 S 137TH WEST AVE
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City | SAND SPRINGS
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State | OK
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Zip | 74063-5017
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Country | US
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Telephone | 918-245-0231
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | OK
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