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NPI Code Detail

MEDICARE: SHELLETA HARRIS

MEDICARE: SHELLETA HARRIS
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
1106S00000XBehavior Technician
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1154990406
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLETA HARRIS
Provider Business Mailing Address
First Line : 1200 N WHITE SANDS BLVD STE 121
Second Line :
City : ALAMOGORDO
State : NM
Zip : 88310-6774
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2325 CERRILLOS RD
Second Line :
City : SANTA FE
State : NM
Zip : 87505-3377
Country : US
Telephone Number : 505-438-0010
Fax Number : 505-438-6011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2021
Last Update Date : 10/12/2022

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Directions to “ SHELLETA HARRIS ” Practice Location

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