Provider Demographics
NPI:1841544988
Name:SHANKLIN, GARTH RAY (MS, LPC)
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:RAY
Last Name:SHANKLIN
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 CRYSTIE LN
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2338
Mailing Address - Country:US
Mailing Address - Phone:307-267-2111
Mailing Address - Fax:307-237-5568
Practice Address - Street 1:125 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4612
Practice Address - Country:US
Practice Address - Phone:307-268-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY026101YA0400X
WY007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)