Provider Demographics
NPI:1629775309
Name:EVERETT, SHANNON (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 NW ABBEY CT
Mailing Address - Street 2:
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394-9429
Mailing Address - Country:US
Mailing Address - Phone:805-628-6058
Mailing Address - Fax:
Practice Address - Street 1:1722 NW ABBEY CT
Practice Address - Street 2:
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394-9429
Practice Address - Country:US
Practice Address - Phone:805-628-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-64031103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst