Provider Demographics
NPI:1518556133
Name:HUTCHINSON, SHAMARLA TEAKE (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:SHAMARLA
Middle Name:TEAKE
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:MS
Other - First Name:SHAMARLA
Other - Middle Name:TEAKE
Other - Last Name:PARKS-BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:1008 GREEN PINE BLVD APT H1
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7019
Mailing Address - Country:US
Mailing Address - Phone:754-367-1087
Mailing Address - Fax:
Practice Address - Street 1:2119 10TH AVE N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-3345
Practice Address - Country:US
Practice Address - Phone:754-367-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-24-15117106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst