Provider Demographics
NPI:1578681698
Name:SHOOK, TIFFANY (BA, BHRS, CM-CAF)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SHOOK
Suffix:
Gender:F
Credentials:BA, BHRS, CM-CAF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 MAVERICK LANE
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644
Mailing Address - Country:US
Mailing Address - Phone:580-799-1902
Mailing Address - Fax:
Practice Address - Street 1:306 MAVERICK LANE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644
Practice Address - Country:US
Practice Address - Phone:580-799-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator