Individual
SHELLY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6060 N WILDHORSE DR, PRESCOTT VALLEY, AZ 86314-3346
(760) 644-3670
Mailing address
6060 N WILDHORSE DR, PRESCOTT VALLEY, AZ 86314-3346
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
BH4554
AZ
Other
Enumeration date
09/18/2015
Last updated
09/18/2015
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