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General NPI Number Information
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NPI Number | 1154856581
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Entity Type | Individual
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Provider Name | SHANAN CONDER LPC, NCSP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 300 W CHEROKEE AVE STE 102
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City | ENID
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State | OK
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Zip | 73701-5600
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Country | US
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Telephone | 580-340-7235
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 OPEN RANGE ST
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City | ENID
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State | OK
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Zip | 73703-7348
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Country | US
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Telephone | 972-302-4358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 66013
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10388
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License Number State | OK
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