Provider Demographics
NPI:1912356999
Name:LEWIS, SHAR'DAE (MA LPC-S)
Entity Type:Individual
Prefix:MS
First Name:SHAR'DAE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55692
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73155-0692
Mailing Address - Country:US
Mailing Address - Phone:405-821-8599
Mailing Address - Fax:
Practice Address - Street 1:909 26TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6366
Practice Address - Country:US
Practice Address - Phone:405-821-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor