Healthcare Provider Details

I. General information

NPI: 1972784189
Provider Name (Legal Business Name): SHAWNA L. TIBBLES MMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 E SKELLY DR SUITE 390
TULSA OK
74105-6317
US

IV. Provider business mailing address

3015 E SKELLY DR SUITE 390
TULSA OK
74105-6317
US

V. Phone/Fax

Practice location:
  • Phone: 918-665-0208
  • Fax: 918-665-0216
Mailing address:
  • Phone: 918-665-0208
  • Fax: 918-665-0216

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: