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General NPI Number Information
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NPI Number | 1972262194
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Entity Type | Individual
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Provider Name | DR. DAVID SHIRLEY
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Gender | Male
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 500 N STATE ROUTE 89
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City | PRESCOTT
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State | AZ
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Zip | 86313-5001
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Country | US
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Telephone | 928-445-4860
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Fax |
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Provider Business Mailing Address
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Address Line | 3470 LEE CIR APT 321
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City | PRESCOTT
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State | AZ
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Zip | 86301-0012
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Country | US
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Telephone | 801-831-3298
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 11407155-2501
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License Number State | UT
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