Individual
GREGORY D. SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
1301 KANSAS HWY 264, LARNED, KS 67550-5353
(620) 285-4216
Mailing address
1301 KANSAS HWY 264, LARNED, KS 67550-5353
(620) 285-4216
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
T-LP 1742
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T-LP 1742
KANSAS STATE LICENSE
KS
Enumeration date
07/22/2008
Last updated
07/22/2008
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