Provider Demographics
NPI:1699212696
Name:SHENELLS
Entity Type:Organization
Organization Name:SHENELLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEJANARA
Authorized Official - Middle Name:DORSHELL
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-655-1451
Mailing Address - Street 1:2120 N HEARNE AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-7183
Mailing Address - Country:US
Mailing Address - Phone:318-655-1451
Mailing Address - Fax:
Practice Address - Street 1:2120 N HEARNE AVE APT 403
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-7183
Practice Address - Country:US
Practice Address - Phone:318-655-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health