Provider Demographics
NPI:1972611887
Name:SHIELDS, PAUL KEITH
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KEITH
Last Name:SHIELDS
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 1:120 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:918-728-3025
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:918-728-3025
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK583101YP2500X
OK54106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-123-5153-01OtherBCBS
OK73-133-6191OtherTAX ID#
OK170392OtherVALUE OPTIONS