Provider Demographics
NPI:1407685662
Name:BOOK, SHELLEY KAY
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:KAY
Last Name:BOOK
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 1:425 BARRACUDA PL
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1521
Mailing Address - Country:US
Mailing Address - Phone:361-774-6123
Mailing Address - Fax:
Practice Address - Street 1:5959 S STAPLES ST STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3844
Practice Address - Country:US
Practice Address - Phone:361-442-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty