Provider Demographics
NPI:1376978171
Name:THREATT, SHARICE REAEL
Entity Type:Individual
Prefix:
First Name:SHARICE
Middle Name:REAEL
Last Name:THREATT
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 1:11229 N PENNSYLVANIA AVE
Mailing Address - Street 2:#528
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7739
Mailing Address - Country:US
Mailing Address - Phone:405-431-6009
Mailing Address - Fax:
Practice Address - Street 1:11229 N PENNSYLVANIA AVE
Practice Address - Street 2:#528
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7739
Practice Address - Country:US
Practice Address - Phone:405-431-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker