Provider Demographics
NPI:1598702987
Name:SHUMATE-JOHNSON, CLEATTA (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CLEATTA
Middle Name:
Last Name:SHUMATE-JOHNSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:PROF
Other - First Name:CLEATTA
Other - Middle Name:
Other - Last Name:SHUMATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:2140 N WACO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-2221
Mailing Address - Country:US
Mailing Address - Phone:918-587-8916
Mailing Address - Fax:
Practice Address - Street 1:3311 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2903
Practice Address - Country:US
Practice Address - Phone:918-747-8282
Practice Address - Fax:918-747-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional