Provider Demographics
NPI:1376030148
Name:SHAPING POSITIVE BEHAVIORS, LLC.
Entity Type:Organization
Organization Name:SHAPING POSITIVE BEHAVIORS, LLC.
Other - Org Name:STACIA EVANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCBA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:LATORRIA
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-503-6170
Mailing Address - Street 1:5175 ELMORE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-5629
Mailing Address - Country:US
Mailing Address - Phone:901-503-6170
Mailing Address - Fax:901-284-0408
Practice Address - Street 1:5175 ELMORE RD STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-5629
Practice Address - Country:US
Practice Address - Phone:901-503-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN340103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ035253Medicaid