Jack, Shelly Denise

Jack, Shelly Denise is an sole proprietor health care provider with primary practice located at 1088 S Gin Rd , Atoka OK 74525-7378. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center). Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) is her primary health care specialty. Jack, Shelly Denise can be contacted via phone (580) 239-2071.

Contact Information

Primary practice address
1088 S Gin Rd Atoka OK 74525-7378
Phone: (580) 239-2071
Fax: (580) 509-5041
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X Oklahoma

Profile Details

NPI number 1447520135
LBN Legal business name Jack, Shelly Denise
Credentials BHRS CM II
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 11th, 2012
Last updated Oct 30th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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