Provider Demographics
NPI:1558175786
Name:SHEA, HEATHER RENEE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:SHEA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 N COUNCIL RD BLDG C
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3131
Mailing Address - Country:US
Mailing Address - Phone:405-889-6366
Mailing Address - Fax:
Practice Address - Street 1:4107 N COUNCIL RD BLDG C
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3131
Practice Address - Country:US
Practice Address - Phone:405-889-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor