Provider Demographics
NPI:1912724816
Name:DR. PAUL K. SHIELDS, INC
Entity type:Organization
Organization Name:DR. PAUL K. SHIELDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:918-494-8807
Mailing Address - Street 1:120 N VANCOUVER AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-8443
Mailing Address - Country:US
Mailing Address - Phone:918-809-1790
Mailing Address - Fax:918-728-3024
Practice Address - Street 1:5525 E 51ST ST STE 530
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7461
Practice Address - Country:US
Practice Address - Phone:918-809-1790
Practice Address - Fax:918-728-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty