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NPI Code Detail

MEDICARE: SHELBY MASSEY MA

MEDICARE: SHELBY MASSEY MA
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
1103TC1900XCounseling PsychologistLMLP03423-TKS

General Provider Information

NPI Number : 1700630795
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY MASSEY MA
Provider Business Mailing Address
First Line : 11316 N INDIANA AVE APT B
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-7945
Country : US
Telephone Number : 405-834-2937
Fax Number :
Provider Business Practice Location Address
First Line : 100 S MAIN ST STE 505
Second Line :
City : WICHITA
State : KS
Zip : 67202-3738
Country : US
Telephone Number : 405-834-2937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2024
Last Update Date : 09/17/2025

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Directions to “ SHELBY MASSEY MA” Practice Location

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