Provider Demographics
NPI:1477982569
Name:SHACKELFORD, DEANNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9209 S WINSTON WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2713
Mailing Address - Country:US
Mailing Address - Phone:405-414-6551
Mailing Address - Fax:
Practice Address - Street 1:9209 S WINSTON WAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2713
Practice Address - Country:US
Practice Address - Phone:405-414-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical