Provider Demographics
NPI:1669032371
Name:COPAS, SHALYN N (BCBA)
Entity Type:Individual
Prefix:
First Name:SHALYN
Middle Name:N
Last Name:COPAS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3732
Mailing Address - Country:US
Mailing Address - Phone:573-872-7453
Mailing Address - Fax:
Practice Address - Street 1:1109 N 11TH ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3732
Practice Address - Country:US
Practice Address - Phone:573-872-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-18-31725103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst