MEDICARE: DR. CHARLES SHAWN OAK PHD, LMFT, LSW

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	35001769A	IN
3	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	:	1861529141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES SHAWN OAK PHD, LMFT, LSW

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/21/2022

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Directions to “ DR. CHARLES SHAWN OAK PHD, LMFT, LSW” Practice Location

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