Provider Demographics
NPI:1366103707
Name:O'BANNON, SHANNA MARIE SCHUELEIN
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:MARIE SCHUELEIN
Last Name:O'BANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:MARIE
Other - Last Name:O'BANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5208 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-6344
Mailing Address - Country:US
Mailing Address - Phone:405-948-4900
Mailing Address - Fax:
Practice Address - Street 1:5208 W RENO AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6344
Practice Address - Country:US
Practice Address - Phone:405-948-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional