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Individual

SHAKILA KASHAWN GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CMII

Contact information

Practice address
14430 NS 3500, KONAWA, OK 74849-4901
(580) 925-2650
Mailing address
14430 NS 3500, KONAWA, OK 74849-4901

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
171M00000X
Case Manager/Care Coordinator

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200128860A
OK
05
200724510A
OK
Enumeration date
06/26/2017
Last updated
12/10/2021
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