Shannon Dreadfulwater, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4733 Issued in OK

Practice address

315 N College Ave
Tahlequah, OK 74464-2703

Phone

(918) 453-1171

NPI assigned

Jul 14, 2010

Last updated

Oct 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1689987059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N COLLEGE AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744642703",
            "telephone_number": "918-453-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 N COLLEGE AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744642703",
            "telephone_number": "918-453-1171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1140 Mayberry Dr",
            "address_purpose": "LOCATION",
            "city": "Tahlequah",
            "state": "OK",
            "postal_code": "744644603",
            "country_code": "US",
            "telephone_number": "918-453-1108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DREADFULWATER",
        "first_name": "SHANNON",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-14",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "4733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Professional Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.