MEDICARE: SHANTEL MITCHELL-COOLEY LCSW

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	104100000X	Social Worker	8089	KS
2	1041C0700X	Clinical Social Worker	149016026	IL
3	1041C0700X	Clinical Social Worker	5827	OK

General Provider Information

NPI Number	:	1255616264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTEL MITCHELL-COOLEY LCSW

Provider Business Mailing Address
First Line	:	3441 W MEMORIAL RD STE 5
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7000
Country	:	US
Telephone Number	:	405-415-4182
Fax Number	:	405-415-4182

Provider Business Practice Location Address
First Line	:	3441 W MEMORIAL RD STE 5
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7000
Country	:	US
Telephone Number	:	405-415-4182
Fax Number	:	405-415-4182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	08/25/2022

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