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General NPI Number Information
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NPI Number | 1396528758
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Entity Type | Individual
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Provider Name | JEWEL LYNNE SHIRLEY BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 6301 HIGHWAY 39
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City | MERIDIAN
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State | MS
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Zip | 39305-9400
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Country | US
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Telephone | 601-812-8368
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 ALAMUCHA WHYNOT RD
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City | TOOMSUBA
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State | MS
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Zip | 39364-8703
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Country | US
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Telephone | 601-616-1585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB771243
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License Number State | MS
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