Individual
MISS SHANTANA SUE ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4502 E 41ST ST, OU IMPACT, TULSA, OK 74135-2536
(918) 660-3150
(918) 660-3143
Mailing address
4502 E 41ST ST STE 1202, TULSA, OK 74135-2536
(918) 660-3150
(918) 660-3143
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
6166
OK
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200532970A
—
OK
Enumeration date
02/25/2014
Last updated
12/05/2024
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