Provider Demographics
NPI:1508909235
Name:TAYLOR, SHAVONNE ETOLIA (MHR LPC)
Entity Type:Individual
Prefix:MS
First Name:SHAVONNE
Middle Name:ETOLIA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MHR LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-6631
Mailing Address - Country:US
Mailing Address - Phone:918-289-0550
Mailing Address - Fax:918-289-0551
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-6631
Practice Address - Country:US
Practice Address - Phone:918-289-0550
Practice Address - Fax:918-289-0551
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health