Provider Demographics
NPI:1487893020
Name:SHUTTS, JOAN BOUNDS (LADC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:BOUNDS
Last Name:SHUTTS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:SHUTTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:RR 1 BOX 45
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73529-9713
Mailing Address - Country:US
Mailing Address - Phone:580-439-5676
Mailing Address - Fax:580-439-6343
Practice Address - Street 1:16 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4940
Practice Address - Country:US
Practice Address - Phone:580-255-8800
Practice Address - Fax:580-255-8842
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK501101Y00000X
OK818101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor