Provider Demographics
NPI:1942740261
Name:COTTON, SHELLEY LEEANN
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LEEANN
Last Name:COTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:LEEANN
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 OAKWOOD LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-4762
Mailing Address - Country:US
Mailing Address - Phone:850-333-0150
Mailing Address - Fax:
Practice Address - Street 1:1846 US HIGHWAY 90 W STE B
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-1408
Practice Address - Country:US
Practice Address - Phone:850-419-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
FL1-23-65398103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst