Basic Information
| Provider Information | |||||||||
| NPI: | 1346680360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANTOR | ||||||||
| FirstName: | SHELLY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, LADC/MH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7010 S YALE AVE | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741365713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184922554 | ||||||||
| FaxNumber: | 9184949870 | ||||||||
| Practice Location | |||||||||
| Address1: | 1516 N LYNN RIGGS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740173567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189233802 | ||||||||
| FaxNumber: | 9189233801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2013 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1336 | OK | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 1336 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.