Provider Demographics
NPI:1851447775
Name:SHOFNER, HAL LEWIS (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:LEWIS
Last Name:SHOFNER
Suffix:
Gender:M
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-717-9840
Mailing Address - Fax:405-942-4790
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:SUITE 950
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-717-9840
Practice Address - Fax:405-942-4790
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK479101YA0400X
OK18441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)