Provider Demographics
NPI:1902008410
Name:ANDERSONBENTLEY, SHIRLEY LEVONE
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:LEVONE
Last Name:ANDERSONBENTLEY
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 1:711 MARTIN LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-1424
Mailing Address - Country:US
Mailing Address - Phone:713-398-1718
Mailing Address - Fax:281-261-2962
Practice Address - Street 1:711 MARTIN LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-1424
Practice Address - Country:US
Practice Address - Phone:713-398-1718
Practice Address - Fax:281-261-2962
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities