Individual
DR. SHELLI SHULTZ JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2500 BOARDWALK STE 203, NORMAN, OK 73069-6593
(405) 329-8501
(405) 253-0581
Mailing address
2500 BOARDWALK STE 203, NORMAN, OK 73069-6593
(405) 329-8501
(405) 253-0581
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
922
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100839280A
—
OK
Enumeration date
08/09/2006
Last updated
12/17/2021
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