Provider Demographics
NPI:1306066469
Name:DEAN, SHANNA RENEE
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:RENEE
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:SHORES
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3908 N PENIEL AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3402
Mailing Address - Country:US
Mailing Address - Phone:405-650-6788
Mailing Address - Fax:
Practice Address - Street 1:3908 N PENIEL AVE STE 500
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3402
Practice Address - Country:US
Practice Address - Phone:405-372-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty