Provider Demographics
NPI:1134405202
Name:ATKINSON, SHERAE ANTOINETTE
Entity type:Individual
Prefix:MRS
First Name:SHERAE
Middle Name:ANTOINETTE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHERAE
Other - Middle Name:ANTOINETTE
Other - Last Name:COLEMAN-ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 SE 48TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2704
Mailing Address - Country:US
Mailing Address - Phone:405-818-1262
Mailing Address - Fax:
Practice Address - Street 1:4300 SE 48TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-2704
Practice Address - Country:US
Practice Address - Phone:405-818-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst