Provider Demographics
NPI:1972677839
Name:BOOKER, SHELLY DENISE
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:DENISE
Last Name:BOOKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHELLY
Other - Middle Name:DENISE
Other - Last Name:CANTU-RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1234 MCHENRY AVE STE A&B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5373
Mailing Address - Country:US
Mailing Address - Phone:209-527-4597
Mailing Address - Fax:209-527-4599
Practice Address - Street 1:1235 MCHENRY AVE STE A&B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5370
Practice Address - Country:US
Practice Address - Phone:209-527-4597
Practice Address - Fax:209-527-4599
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor