Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4075 | AZ |
N | 103T00000X | Psychologist | 4075 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4075 | AZ |
N | 103TA0700X | Adult Development & Aging Psychologist | 4075 | AZ |
N | 103G00000X | Clinical Psychologist | 4075 | AZ |
N | 103TC0700X | Clinical Psychologist | 4075 | AZ |
Y | 103TF0200X | Forensic Psychologist | 4075 | AZ |
NPI | 1811228752 |
---|---|
Provider Name | Dr. Shalene Michele Kirkley |
First Address | Phoenix, AZ 85070-4401 |
Second Address | Phoenix, AZ 85003-1318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 02/09/2010 |