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Individual

SHAKEIA LASHAE BERRY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
11428 E 20TH ST STE A, TULSA, OK 74128-6452
(918) 878-7877
Mailing address
6306 S 107TH EAST AVE APT 3, TULSA, OK 74133-1692
(918) 638-8136

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200442010A
OK
Enumeration date
06/28/2013
Last updated
06/28/2013
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