Provider Demographics
NPI:1619215746
Name:SCHOLTZ, SHANNON LYNN (MS)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LYNN
Last Name:SCHOLTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:LYNN
Other - Last Name:DEOCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1202 SW A AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3821
Mailing Address - Country:US
Mailing Address - Phone:580-574-0289
Mailing Address - Fax:
Practice Address - Street 1:1202 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3821
Practice Address - Country:US
Practice Address - Phone:580-574-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health