Healthcare Provider Details

I. General information

NPI: 1861019895
Provider Name (Legal Business Name): TIFFANY RAYCHELLE SHEPHERD LCSW/MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TIFFANY RAYCHELLE WILLIAMSON

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12005 E 470 RD
CLAREMORE OK
74017-3737
US

IV. Provider business mailing address

12005 E 470 RD
CLAREMORE OK
74017-3737
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-0770
  • Fax: 918-342-0087
Mailing address:
  • Phone: 918-342-0770
  • Fax: 918-342-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21241
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: