Provider Demographics
NPI:1265952733
Name:SHIPMAN, KEILA (LPC)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:BRUNDIDGE
Mailing Address - State:AL
Mailing Address - Zip Code:36010-0734
Mailing Address - Country:US
Mailing Address - Phone:334-309-8981
Mailing Address - Fax:
Practice Address - Street 1:858 S COURT ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4906
Practice Address - Country:US
Practice Address - Phone:334-309-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional