Provider Demographics
NPI:1649761347
Name:DEBORD, SHELBY TIFFANY
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:TIFFANY
Last Name:DEBORD
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:PO BOX 19507
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1968
Mailing Address - Country:US
Mailing Address - Phone:925-813-4517
Mailing Address - Fax:
Practice Address - Street 1:73973 TWO MILE RD APT 154
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-4620
Practice Address - Country:US
Practice Address - Phone:925-813-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker