Healthcare Provider Details

I. General information

NPI: 1407088875
Provider Name (Legal Business Name): MICHELLE LEE SHEBESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 N FLOOD AVE
NORMAN OK
73069-7642
US

IV. Provider business mailing address

861 NEBRASKA ST
NORMAN OK
73069-6949
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-3719
  • Fax:
Mailing address:
  • Phone: 405-831-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: