Provider Demographics
NPI:1588471254
Name:KOONS, SHAYNA (RBT)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:KOONS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 S ELM PL STE 106
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5369
Mailing Address - Country:US
Mailing Address - Phone:918-928-5437
Mailing Address - Fax:888-720-8944
Practice Address - Street 1:19 E DAWES AVE STE A
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4414
Practice Address - Country:US
Practice Address - Phone:918-928-5437
Practice Address - Fax:888-720-8944
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician