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NPI Code Detail

MEDICARE: WILLIAM T SHAHAN LCSW

MEDICARE: WILLIAM T SHAHAN 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
11041C0700XClinical Social Worker2196OK

General Provider Information

NPI Number : 1386749976
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM T SHAHAN LCSW
Provider Business Mailing Address
First Line : 3721 NW 69TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-1715
Country : US
Telephone Number : 405-752-7339
Fax Number : 405-848-5972
Provider Business Practice Location Address
First Line : 6613 N MERIDIAN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-1423
Country : US
Telephone Number : 405-603-8450
Fax Number : 405-848-5972
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 08/15/2008

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