Provider Demographics
NPI:1609671619
Name:HUMPHRIES, SHELBY CHYANNE
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:CHYANNE
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:CHYANNE
Other - Last Name:HUMPHRIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15570 STONY CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4385
Mailing Address - Country:US
Mailing Address - Phone:317-225-2911
Mailing Address - Fax:
Practice Address - Street 1:15570 STONY CREEK WAY
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4385
Practice Address - Country:US
Practice Address - Phone:317-432-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician