Provider Demographics
NPI:1730647082
Name:CLAYBROOKS, SHANICE P (MS,BCBA,LBA)
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:P
Last Name:CLAYBROOKS
Suffix:
Gender:F
Credentials:MS,BCBA,LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 BELLEVUE GROVE CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4801
Mailing Address - Country:US
Mailing Address - Phone:901-283-3486
Mailing Address - Fax:901-284-0998
Practice Address - Street 1:5084 OLD SUMMER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4403
Practice Address - Country:US
Practice Address - Phone:901-283-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-20-43462103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty