Provider Demographics
NPI:1417207622
Name:BROWN, SHATARA L (MA)
Entity Type:Individual
Prefix:
First Name:SHATARA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012
Mailing Address - Country:US
Mailing Address - Phone:972-658-9907
Mailing Address - Fax:
Practice Address - Street 1:3204 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9645
Practice Address - Country:US
Practice Address - Phone:972-658-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor