Provider Demographics
NPI:1114419330
Name:SKANES, SHITAVIA
Entity Type:Individual
Prefix:
First Name:SHITAVIA
Middle Name:
Last Name:SKANES
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 1:1221 SE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-6413
Mailing Address - Country:US
Mailing Address - Phone:405-875-2818
Mailing Address - Fax:
Practice Address - Street 1:5710 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2005
Practice Address - Country:US
Practice Address - Phone:405-455-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health