Healthcare Provider Details

I. General information

NPI: 1841487162
Provider Name (Legal Business Name): SHANNON M. M. DUKES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 DUSTIN DR
NORMAN OK
73071-4881
US

IV. Provider business mailing address

1310 DUSTIN DR
NORMAN OK
73071-4881
US

V. Phone/Fax

Practice location:
  • Phone: 405-615-4464
  • Fax: 405-873-7519
Mailing address:
  • Phone: 405-615-4464
  • Fax: 405-873-7519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3907
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number88142
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3907
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: