Provider Demographics
NPI:1346680360
Name:KANTOR, SHELLY D (MS, LADC/MH)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:D
Last Name:KANTOR
Suffix:
Gender:F
Credentials:MS, LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 S YALE AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5713
Mailing Address - Country:US
Mailing Address - Phone:918-492-2554
Mailing Address - Fax:918-494-9870
Practice Address - Street 1:1516 N LYNN RIGGS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3567
Practice Address - Country:US
Practice Address - Phone:918-923-3802
Practice Address - Fax:918-923-3801
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1336101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health