| Doctor Name: | MS. SHANNA RENELL WILLOUGHBY |
| NPI Number: | 1437345105 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 20028 |
| Business Practice Address: | 300 N Dalton St Valliant, OK - 74764 |
| Business Phone Number: | 5802865777 |
| Business Fax Number: | 5802865132 |
| Mailing Address: | Rr 1 Box 257, GARVIN |
| State: | OK |
| Postal Code: | 747369746 |
| Phone Number: | 5802865777 |
| Fax Number: | 5802865132 |
| NPI Enumeration Date: | 09/17/2007 |
| NPI Last Update Date: | 09/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 20028 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |