Provider Demographics
NPI:1154063527
Name:PHILLIPS-DEAN, SHELLY JO
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:JO
Last Name:PHILLIPS-DEAN
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 1:540 W HORIZON RIDGE PKWY UNIT 1203
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5252
Mailing Address - Country:US
Mailing Address - Phone:910-658-4264
Mailing Address - Fax:
Practice Address - Street 1:540 W HORIZON RIDGE PKWY UNIT 1203
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5252
Practice Address - Country:US
Practice Address - Phone:910-658-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician