Doctor Name: | GREGORY D. SHANNON |
NPI Number: | 1700041456 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D |
License Number: | T-LP 1742 |
Business Practice Address: | 1301 Kansas Hwy 264 Larned, KS - 675505353 |
Business Phone Number: | 6202854216 |
Business Fax Number: | |
Mailing Address: | 1301 Kansas Hwy 264, LARNED |
State: | KS |
Postal Code: | 675505353 |
Phone Number: | 6202854216 |
Fax Number: | |
NPI Enumeration Date: | 07/22/2008 |
NPI Last Update Date: | 07/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | T-LP 1742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |