Provider Demographics
NPI:1295400281
Name:ROSALIK, SHELBY (BCBA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ROSALIK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 UNION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6514
Mailing Address - Country:US
Mailing Address - Phone:303-989-8169
Mailing Address - Fax:303-984-4366
Practice Address - Street 1:15703 LONGENBAUGH DR STE H
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1649
Practice Address - Country:US
Practice Address - Phone:303-989-8169
Practice Address - Fax:303-984-4366
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4276103K00000X
TX1-21-51655103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst