Provider Demographics
NPI:1578310280
Name:SHOOK, LYNN LOUISE
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:LOUISE
Last Name:SHOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:LOUISE
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4016
Mailing Address - Country:US
Mailing Address - Phone:405-317-4692
Mailing Address - Fax:
Practice Address - Street 1:4805 RICHMOND SQ
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2058
Practice Address - Country:US
Practice Address - Phone:405-767-1126
Practice Address - Fax:405-767-6285
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional