Provider Demographics
NPI:1790983617
Name:BURNS, SHANTEL DENISE (BA, MHR)
Entity Type:Individual
Prefix:MRS
First Name:SHANTEL
Middle Name:DENISE
Last Name:BURNS
Suffix:
Gender:F
Credentials:BA, MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 EAST ALMAR
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018
Mailing Address - Country:US
Mailing Address - Phone:405-222-5437
Mailing Address - Fax:405-222-5441
Practice Address - Street 1:198 EAST ALMAR
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018
Practice Address - Country:US
Practice Address - Phone:405-222-5437
Practice Address - Fax:405-222-5441
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3SDB68OtherICIS