MEDICARE: MR. MARK WARD SHREFFLER LPC

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	101YP2500X	Professional Counselor
2	101YP2500X	Professional Counselor	1313	OK

General Provider Information

NPI Number	:	1457436453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK WARD SHREFFLER LPC

Provider Business Mailing Address
First Line	:	10948 NW EXPRESSWAY STE 10
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-8787
Country	:	US
Telephone Number	:	405-596-1893
Fax Number	:	405-883-6051

Provider Business Practice Location Address
First Line	:	3516 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5630
Country	:	US
Telephone Number	:	405-596-1893
Fax Number	:	405-943-7501

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	04/28/2021

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