Healthcare Provider Details

I. General information

NPI: 1093072159
Provider Name (Legal Business Name): SHAYANNA ESPINOSA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAYANNA TRIMBLE

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 S WESTERN AVE
OKLAHOMA CITY OK
73139
US

IV. Provider business mailing address

404 N MORGAN DR
MOORE OK
73160-6947
US

V. Phone/Fax

Practice location:
  • Phone: 405-641-2639
  • Fax:
Mailing address:
  • Phone: 405-641-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: