Provider Demographics
NPI:1578086898
Name:MANNING, SHAUN DAVID (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:DAVID
Last Name:MANNING
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 S EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8707
Mailing Address - Country:US
Mailing Address - Phone:918-809-2575
Mailing Address - Fax:
Practice Address - Street 1:2840 E 51ST ST STE 105
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-1707
Practice Address - Country:US
Practice Address - Phone:918-747-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health