Provider Demographics
NPI:1134697451
Name:SHAPPLEY, ZACHARY WAYNE
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:WAYNE
Last Name:SHAPPLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3597 WATERFORD CV S
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8977
Mailing Address - Country:US
Mailing Address - Phone:901-485-2853
Mailing Address - Fax:
Practice Address - Street 1:52 TIMBER CREEK DR STE 203
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4388
Practice Address - Country:US
Practice Address - Phone:662-536-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist