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General NPI Number Information
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NPI Number | 1932754363
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Entity Type | Organization
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Legal Business Name | PROACTIVE BEHAVIOR & SOLUTIONS
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 2626 SCENIC POINT
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City | ARLINGTON
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State | TX
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Zip | 76006
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Country | US
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Telephone | 225-252-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 18291 MANCHAC PLACE DR
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3355
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Country | US
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Telephone | 225-252-3655
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SIMONE ELLOIE SHELTON
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Credential | ED. D
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Telephone | 225-252-3655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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