Provider Demographics
NPI:1477850501
Name:SHACKLOCK, HOWARD A JR (MS)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:A
Last Name:SHACKLOCK
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MARKET ST
Mailing Address - Street 2:ACRP INC
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1628
Mailing Address - Country:US
Mailing Address - Phone:814-361-2414
Mailing Address - Fax:
Practice Address - Street 1:131 MARKET ST
Practice Address - Street 2:ACRP INC
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1628
Practice Address - Country:US
Practice Address - Phone:814-361-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst