1205260940 NPI number — MAHRI WESTPHAL PALMER SHELTON M.ED. BCBA

Table of content: MAHRI WESTPHAL PALMER SHELTON M.ED. BCBA (NPI 1205260940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205260940 NPI number — MAHRI WESTPHAL PALMER SHELTON M.ED. BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELTON
Provider First Name:
MAHRI
Provider Middle Name:
WESTPHAL PALMER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED. BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205260940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 W ML KING JR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31313-3226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-320-4378
Provider Business Mailing Address Fax Number:
866-467-4321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 N MAIN ST STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31313-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-320-4378
Provider Business Practice Location Address Fax Number:
866-467-4321
Provider Enumeration Date:
08/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-16-24669 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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