Provider Demographics
NPI:1992422752
Name:COKELY, SHIANNE B
Entity type:Individual
Prefix:
First Name:SHIANNE
Middle Name:B
Last Name:COKELY
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 1:421 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-2902
Mailing Address - Country:US
Mailing Address - Phone:316-518-0545
Mailing Address - Fax:
Practice Address - Street 1:205 E 7TH ST STE 409
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4907
Practice Address - Country:US
Practice Address - Phone:316-518-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health