MEDICARE: MRS. SHANNA L EISCHEN MS, LPC, IMH-II

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1912345463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNA L EISCHEN MS, LPC, IMH-II

Provider Business Mailing Address
First Line	:	6308 E 15TH ST STE 2C
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-6411
Country	:	US
Telephone Number	:	918-695-0996
Fax Number	:

Provider Business Practice Location Address
First Line	:	6308 E 15TH ST STE 2C
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-6411
Country	:	US
Telephone Number	:	918-695-0996
Fax Number	:	918-699-0598

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

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	07/29/2020

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