MEDICARE: SHANNA EISCHEN CONSULTING AND COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013527944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNA EISCHEN CONSULTING AND COUNSELING LLC

Provider Business Mailing Address
First Line	:	6308 E 15TH ST STE 2C
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-6411
Country	:	US
Telephone Number	:	918-695-0996
Fax Number	:

Provider Business Practice Location Address
First Line	:	6308 E 15TH ST STE 2C
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-6411
Country	:	US
Telephone Number	:	918-695-0996
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND PROVIDER
Name	:	MRS. SHANNA L EISCHEN
Credential	:	MS, LPC, IMH-II
Telephone Number	:	918-695-0996

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	08/05/2020

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