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Individual

DR. SHANEQUIA DESHAWN CLEMONS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2180 REESE ST, LACKLAND AFB, TX 78236-1042
(305) 912-3482
Mailing address
2180 REESE ST, LACKLAND AFB, TX 78236-1042
(210) 606-2319

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
TX
175T00000X
Peer Specialist
TX
225400000X
Rehabilitation Practitioner
Primary
TX
374K00000X
Religious Nonmedical Practitioner
TX

Other

Enumeration date
12/14/2017
Last updated
11/23/2022
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