MEDICARE: MRS. SHAWNA MICHELE JILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1144456351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAWNA MICHELE JILES

Provider Business Mailing Address
First Line	:	5850 GRANITE PKWY STE 600
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-6753
Country	:	US
Telephone Number	:	818-346-2345
Fax Number	:	916-394-1010

Provider Business Practice Location Address
First Line	:	6939 SUNRISE BLVD STE 107
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-3153
Country	:	US
Telephone Number	:	916-547-5908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	11/03/2022

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