Provider Demographics
NPI:1568015683
Name:MORRISON, SHELBI (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5856 W CAVENDALE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5805
Mailing Address - Country:US
Mailing Address - Phone:360-791-7192
Mailing Address - Fax:
Practice Address - Street 1:5856 W CAVENDALE DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5805
Practice Address - Country:US
Practice Address - Phone:360-791-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-29735103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst