Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 261QM0801X | OK |
NPI | 1023359734 |
---|---|
Provider Name | Ms. Denise Lashaun Shaw |
First Address | Del City, OK 73115-1333 |
Second Address | Oklahoma City, OK 73112-7070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2013 |
Last Update Date | 05/03/2013 |