Provider Demographics
NPI:1205615317
Name:GREENE, SHELLEY B
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:B
Last Name:GREENE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:H
Other - Last Name:BRANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2764 BREVARD DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2235
Mailing Address - Country:US
Mailing Address - Phone:334-437-0011
Mailing Address - Fax:
Practice Address - Street 1:3100 COTTAGE HILL RD STE 400
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2913
Practice Address - Country:US
Practice Address - Phone:251-235-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-22-208301106S00000X
AL1-24-75796103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician