Provider Demographics
NPI:1821662610
Name:SHELTON, MIRANDA (MSW-P)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MSW-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4222
Mailing Address - Country:US
Mailing Address - Phone:918-313-2261
Mailing Address - Fax:
Practice Address - Street 1:604 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4222
Practice Address - Country:US
Practice Address - Phone:918-313-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK20927-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator