Provider Demographics
NPI:1003104217
Name:MINER, SHELBY MARIE (BCABA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:MINER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33568
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3568
Mailing Address - Country:US
Mailing Address - Phone:855-223-7123
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:725 S MESA HILLS DR BLDG 3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5568
Practice Address - Country:US
Practice Address - Phone:800-515-5016
Practice Address - Fax:619-374-7134
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-18824103K00000X
CABCABA: 0-11-4018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst