Provider Demographics
NPI:1649722844
Name:SILLS, SHANA RACHELLE
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:RACHELLE
Last Name:SILLS
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:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0014
Mailing Address - Country:US
Mailing Address - Phone:972-524-4159
Mailing Address - Fax:972-524-1002
Practice Address - Street 1:1300 W 16TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2046
Practice Address - Country:US
Practice Address - Phone:903-572-8783
Practice Address - Fax:903-572-6965
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX566751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical