MEDICARE: SHELLI MAGIN 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	78834	TX
2	101YM0800X	Mental Health Counselor	7773	OK

General Provider Information

NPI Number	:	1992276034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLI MAGIN LPC

Provider Business Mailing Address
First Line	:	2225 N UNION ST.
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1536
Country	:	US
Telephone Number	:	918-308-5515
Fax Number	:	580-749-5792

Provider Business Practice Location Address
First Line	:	2225 N UNION ST.
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1536
Country	:	US
Telephone Number	:	918-308-5515
Fax Number	:	580-749-5792

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

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	03/15/2021

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Directions to “ SHELLI MAGIN LPC” Practice Location

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