Doctor Name: | CHARLES H SHIELDS |
NPI Number: | 1114170057 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | THERAPIST |
License Number: | |
Business Practice Address: | 2003 Se Walton Blvd Bentonville, AR - 727123725 |
Business Phone Number: | 4794645925 |
Business Fax Number: | 4795216520 |
Mailing Address: | 3352 N Futrall Dr, FAYETTEVILLE |
State: | AR |
Postal Code: | 727034057 |
Phone Number: | 4795215731 |
Fax Number: | 4795216520 |
NPI Enumeration Date: | 10/23/2008 |
NPI Last Update Date: | 10/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |