Healthcare Provider Details

I. General information

NPI: 1437088119
Provider Name (Legal Business Name): SHANNON GAUMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N GILBERT RD STE 203
GILBERT AZ
85234-4724
US

IV. Provider business mailing address

924 W PINON AVE
GILBERT AZ
85233-3761
US

V. Phone/Fax

Practice location:
  • Phone: 480-477-3203
  • Fax:
Mailing address:
  • Phone: 814-279-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-22885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: