Doctor Name: | SHANLEY DONELAN MANGEOT |
NPI Number: | 1215190467 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2637 |
Business Practice Address: | 710 Cooper Ave Suite 120 Glenwood Springs, CO - 816013455 |
Business Phone Number: | 9709459841 |
Business Fax Number: | |
Mailing Address: | 710 Cooper Ave, Suite 120 GLENWOOD SPRINGS |
State: | CO |
Postal Code: | 816013455 |
Phone Number: | 9709459841 |
Fax Number: | |
NPI Enumeration Date: | 07/08/2008 |
NPI Last Update Date: | 07/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2637 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |