Healthcare Provider Details

I. General information

NPI: 1831431790
Provider Name (Legal Business Name): SHAMEKIA OGUNTIMILEHIN COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5714 S WESTERN AVE SUITE D
OKLAHOMA CITY OK
73109-4515
US

IV. Provider business mailing address

5714 S WESTERN AVE SUITE D
OKLAHOMA CITY OK
73109-4515
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-6055
  • Fax: 405-634-6061
Mailing address:
  • Phone: 405-634-6055
  • Fax: 405-634-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: