Provider Demographics
NPI:1003240714
Name:WILLIAMS-WALKER, SHANON
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:
Last Name:WILLIAMS-WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E DAWES AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4417
Mailing Address - Country:US
Mailing Address - Phone:918-344-2986
Mailing Address - Fax:
Practice Address - Street 1:222 E DAWES AVE
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4417
Practice Address - Country:US
Practice Address - Phone:918-344-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health