Provider Demographics
NPI:1124471792
Name:SHIPLEY, FAITH OLIVIA
Entity type:Individual
Prefix:MS
First Name:FAITH
Middle Name:OLIVIA
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 HEARNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-3803
Mailing Address - Country:US
Mailing Address - Phone:183-213-1389
Mailing Address - Fax:318-213-1388
Practice Address - Street 1:2509 SHERI LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-3025
Practice Address - Country:US
Practice Address - Phone:318-820-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional