Provider Demographics
NPI:1427296334
Name:DAVIS, SHELLEY ELAINE (LMSW)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ELAINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:ELAINE
Other - Last Name:LEEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:P.O. BOX 4000
Mailing Address - Street 2:JAMES H QUILLEN VA MEDICAL CENTER
Mailing Address - City:MOUNTIAN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-979-2605
Mailing Address - Fax:423-797-3451
Practice Address - Street 1:100 CORNER OF SIDNEY & LAMONT
Practice Address - Street 2:BUILDING 200
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2605
Practice Address - Fax:423-797-3451
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7563104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker