Healthcare Provider Details

I. General information

NPI: 1386749976
Provider Name (Legal Business Name): WILLIAM T SHAHAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 N MERIDIAN AVE
OKLAHOMA CITY OK
73116-1423
US

IV. Provider business mailing address

3721 NW 69TH ST
OKLAHOMA CITY OK
73116-1715
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-8450
  • Fax: 405-848-5972
Mailing address:
  • Phone: 405-752-7339
  • Fax: 405-848-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2196
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: