Provider Demographics
NPI:1639644412
Name:SHANTEL FARROW
Entity Type:Organization
Organization Name:SHANTEL FARROW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:SHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FARROW
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:405-881-5687
Mailing Address - Street 1:9624 NE 3RD PL
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3407
Mailing Address - Country:US
Mailing Address - Phone:405-881-5687
Mailing Address - Fax:
Practice Address - Street 1:114 N GRAND AVE STE 212
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4030
Practice Address - Country:US
Practice Address - Phone:405-881-5687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health