Provider Demographics
NPI:1962235481
Name:SHUCK, PAULA MARIE
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:SHUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CHEROKEE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5600
Mailing Address - Country:US
Mailing Address - Phone:405-426-5594
Mailing Address - Fax:
Practice Address - Street 1:300 W CHEROKEE AVE STE 102
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5600
Practice Address - Country:US
Practice Address - Phone:405-426-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor