Provider Demographics
NPI:1639668296
Name:WHITESHIRT, CLAUDE MARY (LPC)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:MARY
Last Name:WHITESHIRT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2081
Mailing Address - Country:US
Mailing Address - Phone:918-931-0333
Mailing Address - Fax:
Practice Address - Street 1:1516 N 20TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2081
Practice Address - Country:US
Practice Address - Phone:918-931-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional