Provider Demographics
NPI:1649579905
Name:SMITH, SHELLEY ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:ELIZABETH
Last Name:SMITH
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 1:910 ARBOR KNOLL BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5353
Mailing Address - Country:US
Mailing Address - Phone:615-489-3806
Mailing Address - Fax:
Practice Address - Street 1:910 ARBOR KNOLL BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5353
Practice Address - Country:US
Practice Address - Phone:615-489-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health