Provider Demographics
NPI:1972784189
Name:TIBBLES, SHAWNA L (MMFT)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:L
Last Name:TIBBLES
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 E SKELLY DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6317
Mailing Address - Country:US
Mailing Address - Phone:918-665-0208
Mailing Address - Fax:918-665-0216
Practice Address - Street 1:3015 E SKELLY DR
Practice Address - Street 2:SUITE 390
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6317
Practice Address - Country:US
Practice Address - Phone:918-665-0208
Practice Address - Fax:918-665-0216
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health