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General NPI Number Information
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NPI Number | 1194006387
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Entity Type | Individual
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Provider Name | SHANNON HENDERSON M.S., LPC CANDIDATE
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Gender | Male
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 1140 N HUDSON AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-3918
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Country | US
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Telephone | 405-858-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 6116 N MERIDIAN AVE APT 602
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-1277
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Country | US
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Telephone | 918-695-7853
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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 |
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License Number State |
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