Provider Demographics
NPI:1881985653
Name:SHANKS, GREGORY F (MA, LCPC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:SHANKS
Suffix:
Gender:M
Credentials:MA, LCPC
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 17213
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-7213
Mailing Address - Country:US
Mailing Address - Phone:406-327-3350
Mailing Address - Fax:406-327-3396
Practice Address - Street 1:235 N 1ST ST W STE C
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3661
Practice Address - Country:US
Practice Address - Phone:406-214-9697
Practice Address - Fax:406-728-5178
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional