MEDICARE: MS. SHANNA RENELL WILLOUGHBY

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	20028	OK

General Provider Information

NPI Number	:	1437345105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNA RENELL WILLOUGHBY

Provider Business Mailing Address
First Line	:	RR 1 BOX 257
Second Line	:
City	:	GARVIN
State	:	OK
Zip	:	74736-9746
Country	:	US
Telephone Number	:	580-286-5777
Fax Number	:	580-286-5132

Provider Business Practice Location Address
First Line	:	300 N DALTON ST
Second Line	:
City	:	VALLIANT
State	:	OK
Zip	:	74764
Country	:	US
Telephone Number	:	580-286-5777
Fax Number	:	580-286-5132

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	09/17/2007

Similar Medicare Providers

1184683807 — VALLIANT PUBLIC SCHOOLS
Practice Location Address:

604 E LUCAS ST
VALLIANT, OK
74764-9076

Practice Phone: 580-933-7232
Practice Fax: 580-933-7289

1457380750 — NICKI J FOXX CRNA
Practice Location Address:

RR 2 BOX 240
VALLIANT, OK
74764-9735

Practice Phone: 580-746-2317
Practice Fax:

1528079555 — DR. DARRELL REED SUHR DDS
Practice Location Address:

RR 2 BOX 328
VALLIANT, OK
74764-9739

Practice Phone: 580-746-2238
Practice Fax: 580-746-2439

1942211966 — DR. ROBERTA ANN SUHR DDS
Practice Location Address:

16333 W US HIGHWAY 70
VALLIANT, OK
74764-5598

Practice Phone: 580-746-2238
Practice Fax: 580-746-2439

1750470969 — BOLTON DRUG & JEWELRY
Practice Location Address:

#3 N DALTON
VALLIANT, OK
74764

Practice Phone: 580-933-4214
Practice Fax: 580-933-7605

1811042591 — JOHNNIE LYNNETTE WEST MS,LPC,MHP
Practice Location Address:

RR 2 BOX 497
VALLIANT, OK
74764-9793

Practice Phone: 580-743-6214
Practice Fax:

1720118276 — MRS. ALTIS BEATRICE RUTHERFORD BA,BHRS, CM-A
Practice Location Address:

300 N DALTON
VALLIANT, OK
74764

Practice Phone: 580-286-6638
Practice Fax: 580-286-5206

Directions to “ MS. SHANNA RENELL WILLOUGHBY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.