Provider Demographics
NPI:1558444935
Name:SHAHAN, ROBERT JUDSON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JUDSON
Last Name:SHAHAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1532
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1532
Mailing Address - Country:US
Mailing Address - Phone:405-366-6068
Mailing Address - Fax:
Practice Address - Street 1:2420 SPRINGER DR
Practice Address - Street 2:SUITE 215
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3965
Practice Address - Country:US
Practice Address - Phone:405-366-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical