| Doctor Name: | LISA ADRIENNE SHANKLIN |
| NPI Number: | 1114017035 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 2902 E Kiehl Ave Suite 1a Sherwood, AR - 721203226 |
| Business Phone Number: | 5018342727 |
| Business Fax Number: | 5018342242 |
| Mailing Address: | 16401 Chenal Valley Dr, Apt 6107 LITTLE ROCK |
| State: | AR |
| Postal Code: | 722233905 |
| Phone Number: | 5014482462 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2006 |
| NPI Last Update Date: | 02/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |