Provider Demographics
NPI:1659082907
Name:SHAPE CENTER
Entity Type:Organization
Organization Name:SHAPE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:NINETTE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:THREATT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:323-717-9568
Mailing Address - Street 1:326 N LBJ DR STE 198
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5624
Mailing Address - Country:US
Mailing Address - Phone:323-717-9568
Mailing Address - Fax:
Practice Address - Street 1:326 N LBJ DR STE 198
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5624
Practice Address - Country:US
Practice Address - Phone:323-717-9568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health