MEDICARE: SHELLY HOLDER LPC

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
1	101YP2500X	Professional Counselor	3516	OK

General Provider Information

NPI Number	:	1124417027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY HOLDER LPC

Provider Business Mailing Address
First Line	:	704 SW 111TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5806
Country	:	US
Telephone Number	:	405-474-9614
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 SW 111TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5806
Country	:	US
Telephone Number	:	405-474-9614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “ SHELLY HOLDER LPC” Practice Location

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