Healthcare Provider Details

I. General information

NPI: 1538457569
Provider Name (Legal Business Name): SHONTA YANETTE CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 11/27/2023
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 IDAHO AVE
BARTLESVILLE OK
74006-2420
US

IV. Provider business mailing address

PO BOX 3492
BARTLESVILLE OK
74006-3492
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-8080
  • Fax: 918-337-8099
Mailing address:
  • Phone: 918-766-6998
  • Fax: 918-876-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5264
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: