Provider Demographics
NPI:1952443574
Name:BUCKLEY, SHAYLA DANIELLE
Entity Type:Individual
Prefix:MRS
First Name:SHAYLA
Middle Name:DANIELLE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 N BOSTON PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-2208
Mailing Address - Country:US
Mailing Address - Phone:539-664-4675
Mailing Address - Fax:
Practice Address - Street 1:2616 N BOSTON PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-2208
Practice Address - Country:US
Practice Address - Phone:539-664-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK6062101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator