Heather Michelle Shores

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

501 N 1St St
Madill, OK 73446-1406

Phone

(580) 798-0111

NPI assigned

Apr 22, 2024

Last updated

Apr 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lighthouse Behavioral Wellness Centers

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madill, OK
  • NPI 1972659910
  NPD
• Lighthouse Behavioral Wellness Centers

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ardmore, OK
  • NPI 1881884807
  NPD (past)

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

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1740035914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14651 GARY RD",
            "city": "MADILL",
            "state": "OK",
            "postal_code": "734468143",
            "telephone_number": "580-263-4305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N 1ST ST",
            "city": "MADILL",
            "state": "OK",
            "postal_code": "734461406",
            "telephone_number": "580-798-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORES",
        "first_name": "HEATHER",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Rowley
• Tanya Royal
• SCG Madill Brookside LLC (Brookside Nursing Center)
• Brandy N Schultz
• Deborah Leah Self, M.S.,C.C.C.
• Sharon Shumaker Smith
• Southeastern Oklahoma Family Services, Inc.
• Southern Oklahoma Treatment Services, Inc.
• Crystal Spencer, LPC
• Jonathan Spiva, D.C.

• Peer Specialist in Madill, OK
• Providers in Madill, OK by specialty
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.