Provider Demographics
NPI:1114371309
Name:BOOZER, SHELBY (BCBA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:BOOZER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 W IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3154
Mailing Address - Country:US
Mailing Address - Phone:615-299-6332
Mailing Address - Fax:
Practice Address - Street 1:652 W IRIS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3154
Practice Address - Country:US
Practice Address - Phone:615-299-6332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-21590103K00000X
1-16-21590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst