Provider Demographics
NPI:1255644522
Name:FRANKLIN SHOALS, KIMBERLY SHANIQUE (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHANIQUE
Last Name:FRANKLIN SHOALS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:SHANIQUE
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1129 N HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-4021
Mailing Address - Country:US
Mailing Address - Phone:405-272-1610
Mailing Address - Fax:
Practice Address - Street 1:214 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-6506
Practice Address - Country:US
Practice Address - Phone:405-272-1610
Practice Address - Fax:405-272-1630
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional