Healthcare Provider Details

I. General information

NPI: 1457024515
Provider Name (Legal Business Name): ALEXANDER C SHEKOUH LPC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S MUSTANG RD STE B
YUKON OK
73099-7314
US

IV. Provider business mailing address

416 S MUSTANG RD STE B
YUKON OK
73099-7314
US

V. Phone/Fax

Practice location:
  • Phone: 251-458-2958
  • Fax:
Mailing address:
  • Phone: 251-458-2958
  • 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: