Healthcare Provider Details

I. General information

NPI: 1275994956
Provider Name (Legal Business Name): SHELBY REEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31947 LITTLE FLOCK CIRCLE
WALKER LA
70785
US

IV. Provider business mailing address

31974 LITTLE FLOCK CIR
WALKER LA
70785-4628
US

V. Phone/Fax

Practice location:
  • Phone: 225-717-7115
  • Fax:
Mailing address:
  • Phone: 225-717-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: