Individual
SHELBY SANDIFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1920 DUNBARTON DR, JACKSON, MS 39216-5001
(601) 982-5376
Mailing address
1920 DUNBARTON DR, JACKSON, MS 39216-5001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2371
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2371
BLUE CROSS BLUE SHIELD
MS
Enumeration date
04/17/2019
Last updated
06/11/2019
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