Provider Demographics
NPI:1932754363
Name:PROACTIVE BEHAVIOR & SOLUTIONS
Entity Type:Organization
Organization Name:PROACTIVE BEHAVIOR & SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:ELLOIE
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:225-252-3655
Mailing Address - Street 1:18291 MANCHAC PLACE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3355
Mailing Address - Country:US
Mailing Address - Phone:225-252-3655
Mailing Address - Fax:
Practice Address - Street 1:2626 SCENIC POINT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006
Practice Address - Country:US
Practice Address - Phone:225-252-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health