Provider Demographics
NPI:1083315899
Name:BROWN, SHELBY B (MED BCBA LBA)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED BCBA LBA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:B
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9785
Mailing Address - Country:US
Mailing Address - Phone:502-271-8250
Mailing Address - Fax:
Practice Address - Street 1:105 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1307
Practice Address - Country:US
Practice Address - Phone:606-677-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282668103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst