Healthcare Provider Details

I. General information

NPI: 1396448460
Provider Name (Legal Business Name): SHA'ORI BRIANNE HORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAY HORN

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST
TULSA OK
74135-5012
US

IV. Provider business mailing address

2548 E KENOSHA ST
BROKEN ARROW OK
74014-6712
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-4800
  • Fax:
Mailing address:
  • Phone: 918-355-0993
  • Fax: 918-340-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCANDIDATE12549
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: