Provider Demographics
NPI:1811228752
Name:KIRKLEY, SHALENE MICHELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHALENE
Middle Name:MICHELE
Last Name:KIRKLEY
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:PO BOX 94401
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85070-4401
Mailing Address - Country:US
Mailing Address - Phone:602-284-7741
Mailing Address - Fax:480-219-9685
Practice Address - Street 1:810 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1318
Practice Address - Country:US
Practice Address - Phone:602-284-7741
Practice Address - Fax:480-219-9685
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4075103T00000X, 103TA0400X, 103TA0700X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical