| Doctor Name: | MICHELLE SHIELD |
| NPI Number: | 1255734752 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 405 E Excelsior Ave Vinita, OK - 743014226 |
| Business Phone Number: | 9182566476 |
| Business Fax Number: | 9182563628 |
| Mailing Address: | 114 W Delaware Ave, NOWATA |
| State: | OK |
| Postal Code: | 740482601 |
| Phone Number: | 9182731841 |
| Fax Number: | 9182731843 |
| NPI Enumeration Date: | 09/29/2014 |
| NPI Last Update Date: | 09/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |