Provider Demographics
NPI:1215190467
Name:MANGEOT, SHANLEY DONELAN
Entity Type:Individual
Prefix:
First Name:SHANLEY
Middle Name:DONELAN
Last Name:MANGEOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 COOPER AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3455
Mailing Address - Country:US
Mailing Address - Phone:970-945-9841
Mailing Address - Fax:
Practice Address - Street 1:710 COOPER AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3455
Practice Address - Country:US
Practice Address - Phone:970-945-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical