Provider Demographics
NPI:1558686824
Name:SHIPLE, MARLENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:
Last Name:SHIPLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CAMELBACK RD
Mailing Address - Street 2:SUITE #550
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1668
Mailing Address - Country:US
Mailing Address - Phone:602-266-6662
Mailing Address - Fax:
Practice Address - Street 1:1 E CAMELBACK RD
Practice Address - Street 2:SUITE #550
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1668
Practice Address - Country:US
Practice Address - Phone:602-266-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0908101YP2500X
MT857-LCPC101YP2500X
TX005820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional