Provider Demographics
NPI:1316254352
Name:SAILOR, SHELLEY DINEANE (LPC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DINEANE
Last Name:SAILOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417-0663
Mailing Address - Country:US
Mailing Address - Phone:870-926-3214
Mailing Address - Fax:
Practice Address - Street 1:2801 COUNTY ROAD 762
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-8237
Practice Address - Country:US
Practice Address - Phone:870-926-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1308090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional