Organization
SELF DISCOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEA SELF (BEHAVIOR ANALYST)
(256) 757-6621
Entity
Organization
Contact information
Practice address
1143 COUNTY ROAD 413, KILLEN, AL 35645-7842
(256) 757-6621
Mailing address
PO BOX 161, FLORENCE, AL 35631-0161
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-08-4512
CA
Other
Enumeration date
12/20/2011
Last updated
12/20/2011
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