Provider Demographics
NPI:1174158489
Name:SHOOK, CECILIA R (T-LMFT)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:R
Last Name:SHOOK
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 W 31ST ST S APT 609
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-1169
Mailing Address - Country:US
Mailing Address - Phone:918-914-2740
Mailing Address - Fax:
Practice Address - Street 1:119 JONES ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-1469
Practice Address - Country:US
Practice Address - Phone:620-794-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3146Medicaid