Provider Demographics
NPI:1699494203
Name:DAVIS, SHELBI JUAN ICE
Entity type:Individual
Prefix:
First Name:SHELBI
Middle Name:JUAN ICE
Last Name:DAVIS
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 1:2402 ROBIN RDG
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-6419
Mailing Address - Country:US
Mailing Address - Phone:590-366-9799
Mailing Address - Fax:
Practice Address - Street 1:2402 ROBIN RDG
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-6419
Practice Address - Country:US
Practice Address - Phone:580-366-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor