Healthcare Provider Details

I. General information

NPI: 1760179790
Provider Name (Legal Business Name): BREANNA LEIGH SHELLHORSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 S YALE AVE STE B
TULSA OK
74136-7034
US

IV. Provider business mailing address

7320 S YALE AVE STE B
TULSA OK
74136-7034
US

V. Phone/Fax

Practice location:
  • Phone: 918-992-2335
  • Fax:
Mailing address:
  • Phone: 918-992-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: