Provider Demographics
NPI:1770062531
Name:CANADY, SHAYLA DENISE (MS, MAT)
Entity type:Individual
Prefix:MS
First Name:SHAYLA
Middle Name:DENISE
Last Name:CANADY
Suffix:
Gender:F
Credentials:MS, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9739 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4233
Mailing Address - Country:US
Mailing Address - Phone:501-412-2508
Mailing Address - Fax:
Practice Address - Street 1:2605 BETTY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-5553
Practice Address - Country:US
Practice Address - Phone:318-865-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health