Provider Demographics
NPI:1407112402
Name:MCCHAREN, SHELLY DENISE
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:DENISE
Last Name:MCCHAREN
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 1:11158 LARKIN LN
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3824
Mailing Address - Country:US
Mailing Address - Phone:405-259-6388
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 550
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4538
Practice Address - Country:US
Practice Address - Phone:405-259-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK1192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor