Provider Demographics
NPI:1598971657
Name:SHORES, DIANA KAY (LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:KAY
Last Name:SHORES
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:KAY
Other - Last Name:SHORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0263
Mailing Address - Country:US
Mailing Address - Phone:918-694-1999
Mailing Address - Fax:918-967-8203
Practice Address - Street 1:904 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1653
Practice Address - Country:US
Practice Address - Phone:918-967-8223
Practice Address - Fax:918-967-8203
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK999101YA0400X
OK936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)