Provider Demographics
NPI:1124396304
Name:DUNCAN, SHANNA JO (BACHELORS OF PSY)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:JO
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:BACHELORS OF PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:RINGOLD
Mailing Address - State:OK
Mailing Address - Zip Code:74754-0933
Mailing Address - Country:US
Mailing Address - Phone:580-212-4000
Mailing Address - Fax:
Practice Address - Street 1:303 E COURT ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2047
Practice Address - Country:US
Practice Address - Phone:580-889-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200287120Medicaid