Healthcare Provider Details

I. General information

NPI: 1225313521
Provider Name (Legal Business Name): SHANNA MICHELLE RICE MHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 EAST ALMAR DRIVE
CHICKASHA OK
73018
US

IV. Provider business mailing address

3020 ALLI CIR
CHICKASHA OK
73018-7331
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-5437
  • Fax: 405-222-5452
Mailing address:
  • Phone: 405-320-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1252
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: