Provider Demographics
NPI:1124448105
Name:PETERSON, SHAYLA TRAMAINE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHAYLA
Middle Name:TRAMAINE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:286 CLEAR SKY CT STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8919
Mailing Address - Country:US
Mailing Address - Phone:931-820-1021
Mailing Address - Fax:931-820-1031
Practice Address - Street 1:286 CLEAR SKY CT STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8919
Practice Address - Country:US
Practice Address - Phone:931-820-1021
Practice Address - Fax:931-820-1031
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW117631041C0700X
TNSW59751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical