Provider Demographics
NPI:1902456346
Name:SHAMMO, TERRY CROSBY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:CROSBY
Last Name:SHAMMO
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 1:2250 W CENTER ST BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4921
Mailing Address - Country:US
Mailing Address - Phone:801-834-1025
Mailing Address - Fax:
Practice Address - Street 1:2250 W CENTER ST BLDG 1
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4921
Practice Address - Country:US
Practice Address - Phone:801-834-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor