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SHADAVA DEANN WALLACE
NPI 1215656517
Counselor in Hugo, OK

Active since August 22, 2022
136 MEADOWVIEW ST, HUGO, OK 74743(580) 424-4239 Get Directions Write a Review

NPPES record last updated: August 22, 2022. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Shadava Deann Wallace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADAVA DEANN WALLACE (NPI 1215656517) is an individual counselor in Hugo, Oklahoma and active in the NPI registry since August 2022.

NPPES Registry Identity

NPI1215656517
Entity TypeIndividualFemale
Primary Taxonomy101Y00000X
Provider Legal NameSHADAVA DEANN WALLACE
Location Address136 MEADOWVIEW STHugo, OK 74743-5402
Mailing Address136 Meadowview StHugo, OK 74743-5402 · (580) 424-4239
Phone(580) 424-4239
Sole ProprietorYes
Enumeration DateAugust 22, 2022
NPPES CertifiedAugust 11, 2022
✔ NPI 1215656517 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
136 MEADOWVIEW ST, Hugo, OK 74743
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shadava Wallace's NPI number?

The NPI number for Shadava Wallace is 1215656517. It was assigned to this individual provider in the NPPES registry on August 22, 2022.

Where is Shadava Wallace located?

Shadava Wallace practices at 136 Meadowview St, Hugo, OK 74743. The listed phone number is (580) 424-4239.

What is Shadava Wallace's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

When was this NPI record last updated?

The NPPES record for Shadava Wallace was last updated on August 22, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.