Individual
SHELLEY G SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
(918) 642-5639
Mailing address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
(918) 642-5639
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3049
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200240990A
—
OK
01
—
394452YRHZ
GROUP PTAN
OK
Enumeration date
04/08/2009
Last updated
12/28/2017
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