Provider Demographics
NPI:1447868187
Name:PARRISH, SHANTELL
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:
Last Name:PARRISH
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 1:2940 N CHURCH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-6617
Mailing Address - Country:US
Mailing Address - Phone:801-935-4946
Mailing Address - Fax:801-935-4946
Practice Address - Street 1:1745 N 400 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6721
Practice Address - Country:US
Practice Address - Phone:435-213-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician