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General NPI Number Information
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NPI Number | 1831340041
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Entity Type | Individual
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Provider Name | SHELLY RENEE CUMBERLEDGE CPRSS
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Gender | Female
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 404 E. PINE ST
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City | MARIETTA
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State | OK
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Zip | 73448
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Country | US
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Telephone | 580-276-3323
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Fax | 580-276-3324
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Provider Business Mailing Address
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Address Line | 404 E PINE ST
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City | MARIETTA
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State | OK
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Zip | 73448-4446
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Country | US
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Telephone | 580-276-3323
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Fax | 580-276-3324
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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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