Provider Demographics
NPI:1891164448
Name:GREENE, SHELBY
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:GREENE
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 1:102 GENERAL TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:HAHNVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70057-2025
Mailing Address - Country:US
Mailing Address - Phone:504-427-9387
Mailing Address - Fax:
Practice Address - Street 1:102 GENERAL TAYLOR DR
Practice Address - Street 2:
Practice Address - City:HAHNVILLE
Practice Address - State:LA
Practice Address - Zip Code:70057-2025
Practice Address - Country:US
Practice Address - Phone:504-427-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-119103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst