Provider Demographics
NPI:1962668087
Name:SHELBY, AMBER NICHOLE (CM)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOLE
Last Name:SHELBY
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 HIGHLAND ST
Mailing Address - Street 2:STE 3
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3483
Mailing Address - Country:US
Mailing Address - Phone:731-541-8344
Mailing Address - Fax:731-935-8327
Practice Address - Street 1:238 SUMMAR DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3906
Practice Address - Country:US
Practice Address - Phone:731-541-8344
Practice Address - Fax:731-935-8327
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health