Provider Demographics
NPI:1538423744
Name:SHOPEYIN, MUSIBAU SHOLA (LPC)
Entity type:Individual
Prefix:MR
First Name:MUSIBAU
Middle Name:SHOLA
Last Name:SHOPEYIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 NW 113TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6905
Mailing Address - Country:US
Mailing Address - Phone:405-607-6670
Mailing Address - Fax:
Practice Address - Street 1:832 NW 113TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6905
Practice Address - Country:US
Practice Address - Phone:405-607-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health