Provider Demographics
NPI:1285736769
Name:MONROE, SHIRLEY ANN (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:MONROE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N MAIN AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7242
Mailing Address - Country:US
Mailing Address - Phone:503-860-5692
Mailing Address - Fax:503-618-8600
Practice Address - Street 1:320 N MAIN AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7242
Practice Address - Country:US
Practice Address - Phone:503-860-5692
Practice Address - Fax:503-618-8600
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health