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NPI Code Detail

MEDICARE: SHANNA RENEE DEAN

MEDICARE: SHANNA RENEE DEAN
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
1101YM0800XMental Health Counselor10873OK

General Provider Information

NPI Number : 1306066469
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNA RENEE DEAN
Provider Business Mailing Address
First Line : 3908 N PENIEL AVE STE 500
Second Line :
City : BETHANY
State : OK
Zip : 73008-3402
Country : US
Telephone Number : 405-650-6788
Fax Number :
Provider Business Practice Location Address
First Line : 3908 N PENIEL AVE STE 500
Second Line :
City : BETHANY
State : OK
Zip : 73008-3402
Country : US
Telephone Number : 405-372-1250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2007
Last Update Date : 10/06/2025

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Directions to “ SHANNA RENEE DEAN ” Practice Location

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