Provider Demographics
NPI:1386324333
Name:SHANLEY PSYCHIATRY
Entity type:Organization
Organization Name:SHANLEY PSYCHIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ARNP
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANLEY-SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-844-7871
Mailing Address - Street 1:24702 E MAXWELL LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7532
Mailing Address - Country:US
Mailing Address - Phone:509-844-7871
Mailing Address - Fax:
Practice Address - Street 1:23505 E APPLEWAY AVE STE 200-102
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6003
Practice Address - Country:US
Practice Address - Phone:509-844-7871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty