Provider Demographics
NPI:1568780286
Name:SHAVOR, KEVIN DALE (BS/BHRS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DALE
Last Name:SHAVOR
Suffix:
Gender:M
Credentials:BS/BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-9116
Mailing Address - Country:US
Mailing Address - Phone:580-323-6021
Mailing Address - Fax:580-323-9375
Practice Address - Street 1:94 N 31ST ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-9116
Practice Address - Country:US
Practice Address - Phone:580-323-6021
Practice Address - Fax:580-323-9375
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health