Individual
SHELBY CROCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
146 TIMBER CREEK DR STE 101, CORDOVA, TN 38018-4396
(651) 341-1858
Mailing address
146 TIMBER CREEK DR STE 101, CORDOVA, TN 38018-4396
(651) 341-1858
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-125442
TN
Other
Enumeration date
08/12/2020
Last updated
08/12/2020
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