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NPI Code Detail

MEDICARE: SHEILA SISEMORE L.P.C.

MEDICARE: SHEILA SISEMORE L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor1758OK

General Provider Information

NPI Number : 1104915545
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEILA SISEMORE L.P.C.
Provider Business Mailing Address
First Line : 4300 ROSEBUD LN
Second Line :
City : CHOCTAW
State : OK
Zip : 73020-6086
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2816 NW 57TH ST
Second Line : SUIT 104
City : OKLAHOMA CITY
State : OK
Zip : 73112-7042
Country : US
Telephone Number : 405-848-7882
Fax Number : 405-848-7818
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/08/2007

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Directions to “ SHEILA SISEMORE L.P.C.” Practice Location

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