Provider Demographics
NPI:1407570104
Name:BENNETT, SHELBY RAYLYNN (RBT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:RAYLYNN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 CHAPEL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-5452
Mailing Address - Country:US
Mailing Address - Phone:719-465-3695
Mailing Address - Fax:719-465-3914
Practice Address - Street 1:1740 CHAPEL HILLS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-5452
Practice Address - Country:US
Practice Address - Phone:719-465-3695
Practice Address - Fax:719-465-3914
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician