Provider Demographics
NPI:1861765059
Name:DURANT, MICHELE SHANTAI (BS)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:SHANTAI
Last Name:DURANT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 NW 122ND ST APT 3406
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8459
Mailing Address - Country:US
Mailing Address - Phone:682-622-6897
Mailing Address - Fax:
Practice Address - Street 1:1900 NE 36TH ST STE G
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-5218
Practice Address - Country:US
Practice Address - Phone:405-270-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF083366435101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor