Provider Demographics
NPI:1386253508
Name:FAITHFUL, SHANTELL MARIE
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:MARIE
Last Name:FAITHFUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 E HEBRON PKWY STE 118
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4461
Mailing Address - Country:US
Mailing Address - Phone:469-546-9903
Mailing Address - Fax:
Practice Address - Street 1:3012 E HEBRON PKWY STE 118
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4461
Practice Address - Country:US
Practice Address - Phone:694-546-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician