Provider Demographics
NPI:1164894275
Name:HEARNE, SHYREETA
Entity Type:Individual
Prefix:
First Name:SHYREETA
Middle Name:
Last Name:HEARNE
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 1:5505 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-8739
Mailing Address - Country:US
Mailing Address - Phone:405-863-8083
Mailing Address - Fax:
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD
Practice Address - Street 2:SUITE #108
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3958
Practice Address - Country:US
Practice Address - Phone:405-842-8396
Practice Address - Fax:405-842-8022
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health