Provider Demographics
NPI:1871024752
Name:GRENEKER, SHELLEY SMITH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:SMITH
Last Name:GRENEKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 GREEN CIR STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2784
Mailing Address - Country:US
Mailing Address - Phone:229-244-9688
Mailing Address - Fax:
Practice Address - Street 1:1811 GREEN CIR STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2784
Practice Address - Country:US
Practice Address - Phone:229-244-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001535Other001535