Provider Demographics
NPI:1750097572
Name:CARMAN, SHANE ARTHUR
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:ARTHUR
Last Name:CARMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 RICHMOND SQ STE 110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2040
Mailing Address - Country:US
Mailing Address - Phone:580-649-4425
Mailing Address - Fax:
Practice Address - Street 1:1063 RAINTREE MANSION
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2111
Practice Address - Country:US
Practice Address - Phone:405-519-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst