1194201806 NPI number — ERIKA ALLISON DAVIS SHADE MCMHC, LPC CANDIATE

Table of content: ERIKA ALLISON DAVIS SHADE MCMHC, LPC CANDIATE (NPI 1194201806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194201806 NPI number — ERIKA ALLISON DAVIS SHADE MCMHC, LPC CANDIATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS SHADE
Provider First Name:
ERIKA
Provider Middle Name:
ALLISON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MCMHC, LPC CANDIATE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194201806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 NE 122ND ST APT 1311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73114-9210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-232-6791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1613 SE 66TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73149-5203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-616-3366
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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