Provider Demographics
NPI:1356890552
Name:MCCARTER, SHAUNA (PRSS)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-5025
Mailing Address - Country:US
Mailing Address - Phone:580-745-9276
Mailing Address - Fax:580-920-9056
Practice Address - Street 1:308 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5025
Practice Address - Country:US
Practice Address - Phone:580-745-9276
Practice Address - Fax:580-920-9056
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK35-2341619Medicaid