Provider Demographics
NPI:1003554528
Name:SHOCKLEY, MEREDITH MARGARET
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MARGARET
Last Name:SHOCKLEY
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 1:18521 E QUEEN CREEK RD STE 105-627
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5870
Mailing Address - Country:US
Mailing Address - Phone:480-361-1025
Mailing Address - Fax:480-814-7488
Practice Address - Street 1:1720 10TH AVE. S
Practice Address - Street 2:SUITE 4-150
Practice Address - City:GREAT FALLS
Practice Address - State:MONTANA
Practice Address - Zip Code:59405
Practice Address - Country:UM
Practice Address - Phone:480-361-1025
Practice Address - Fax:480-814-7488
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRBT-22-217169106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician