MEDICARE: MRS. SHELLEY SMITH GRENEKER LMFT

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	106H00000X	Marriage & Family Therapist	001535	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001535	OTHER	GA	001535

General Provider Information

NPI Number	:	1871024752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLEY SMITH GRENEKER LMFT

Provider Business Mailing Address
First Line	:	1811 GREEN CIR STE B
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2784
Country	:	US
Telephone Number	:	229-244-9688
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 GREEN CIR STE B
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2784
Country	:	US
Telephone Number	:	229-244-9688
Fax Number	:

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

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	05/14/2019

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