| Doctor Name: | MISS SHANNON RENEE GREGORY |
| NPI Number: | 1356589402 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4057121 |
| Business Practice Address: | 4725 W South Mountain Ave Laveen, AZ - 85339 |
| Business Phone Number: | 6022377040 |
| Business Fax Number: | 6022373376 |
| Mailing Address: | 5010 E Cheyenne Dr, #1041 PHOENIX |
| State: | AZ |
| Postal Code: | 850441770 |
| Phone Number: | 6144035159 |
| Fax Number: | |
| NPI Enumeration Date: | 01/28/2009 |
| NPI Last Update Date: | 01/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | 4057121 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |