MEDICARE: OAK & ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	33006299A	IN
2	106H00000X	Marriage & Family Therapist	0750	KY
3	171M00000X	Case Manager/Care Coordinator
4	106H00000X	Marriage & Family Therapist	35001769A	IN
5	106H00000X	Marriage & Family Therapist
6	261QM1300X	Multi-Specialty Clinic/Center
7	363L00000X	Nurse Practitioner
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
9	367500000X	Certified Registered Nurse Anesthetist
10	106H00000X	Marriage & Family Therapist	104010	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487957130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK & ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	3303 AUDUBON RIDGE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-1022
Country	:	US
Telephone Number	:	502-594-2829
Fax Number	:	502-416-0467

Provider Business Practice Location Address
First Line	:	2210 GOLDSMITH LN STE 104
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1038
Country	:	US
Telephone Number	:	502-792-0667
Fax Number	:	502-416-0467

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. CHARLES SHAWN OAK
Credential	:	LMFT, LCSW
Telephone Number	:	502-792-0667

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	06/29/2019

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