Provider Demographics
NPI:1013527944
Name:SHANNA EISCHEN CONSULTING AND COUNSELING LLC
Entity Type:Organization
Organization Name:SHANNA EISCHEN CONSULTING AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EISCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, IMH-II
Authorized Official - Phone:918-695-0996
Mailing Address - Street 1:6308 E 15TH ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-6411
Mailing Address - Country:US
Mailing Address - Phone:918-695-0996
Mailing Address - Fax:
Practice Address - Street 1:6308 E 15TH ST STE 2C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-6411
Practice Address - Country:US
Practice Address - Phone:918-695-0996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1912345463Medicaid