Provider Demographics
NPI:1861529141
Name:OAK, CHARLES SHAWN (PHD, LMFT, LSW)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SHAWN
Last Name:OAK
Suffix:
Gender:M
Credentials:PHD, LMFT, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 AUDUBON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1022
Mailing Address - Country:US
Mailing Address - Phone:502-594-2829
Mailing Address - Fax:502-416-0467
Practice Address - Street 1:2210 GOLDSMITH LN STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1038
Practice Address - Country:US
Practice Address - Phone:502-792-0667
Practice Address - Fax:502-416-0467
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33006299A104100000X
IN35001769A106H00000X
KY104010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100320890Medicaid