Provider Demographics
NPI:1417462458
Name:SHELLENBERG, ALISHIA MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:ALISHIA
Middle Name:MARIE
Last Name:SHELLENBERG
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 1:16645 SAGECREEK RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-7911
Mailing Address - Country:US
Mailing Address - Phone:719-200-9315
Mailing Address - Fax:
Practice Address - Street 1:4905 N UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4058
Practice Address - Country:US
Practice Address - Phone:970-219-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-15-09690106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician