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General NPI Number Information
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NPI Number | 1174871107
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Entity Type | Individual
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Provider Name | CLESHAWN DUBOSE
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Gender | Female
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Dates
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Enumeration Date | 08/23/2012
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 4815 S HARVARD AVE STE 275
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City | TULSA
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State | OK
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Zip | 74135-3052
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Country | US
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Telephone | 918-973-3841
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Fax |
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Provider Business Mailing Address
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Address Line | 4815 S HARVARD AVE STE 275
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City | TULSA
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State | OK
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Zip | 74135-3052
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Country | US
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Telephone | 918-973-3841
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6315
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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 | 6315
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6315
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License Number State | OK
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