Provider Demographics
NPI:1417596974
Name:MORAIN, SHELBY (MA,BCBA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MORAIN
Suffix:
Gender:F
Credentials:MA,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CLAIRISE CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3567
Mailing Address - Country:US
Mailing Address - Phone:225-439-7480
Mailing Address - Fax:
Practice Address - Street 1:1670 OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8314
Practice Address - Country:US
Practice Address - Phone:225-439-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst