Healthcare Provider Details

I. General information

NPI: 1982826673
Provider Name (Legal Business Name): SHIRLEY JOYCE BECKENHAUER LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 CLASSEN CIR
OKLAHOMA CITY OK
73118-4429
US

IV. Provider business mailing address

301 W I 240 SERVICE RD
OKLAHOMA CITY OK
73139-7701
US

V. Phone/Fax

Practice location:
  • Phone: 405-810-1766
  • Fax: 405-810-0331
Mailing address:
  • Phone: 405-604-9644
  • Fax: 405-604-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number168
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: