Provider Demographics
NPI:1164799185
Name:DODD, SHAREN (LCSW)
Entity type:Individual
Prefix:
First Name:SHAREN
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S BROWN RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73705-5020
Mailing Address - Country:US
Mailing Address - Phone:801-213-6149
Mailing Address - Fax:
Practice Address - Street 1:138 S BROWN RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73705-5020
Practice Address - Country:US
Practice Address - Phone:580-213-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK204991041C0700X
LA51821041C0700X
UT8191664-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical