Provider Demographics
NPI:1578883955
Name:SHORES, ANGELA LEE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEE
Last Name:SHORES
Suffix:
Gender:F
Credentials:
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 415
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-0415
Mailing Address - Country:US
Mailing Address - Phone:918-839-2450
Mailing Address - Fax:918-420-5717
Practice Address - Street 1:400 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5464
Practice Address - Country:US
Practice Address - Phone:918-420-5238
Practice Address - Fax:918-420-5717
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health