Provider Demographics
NPI:1134625668
Name:MAXWELL, SHELBY (BCBA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MAXWELL
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 1:1543 RINGGOLD AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-2724
Mailing Address - Country:US
Mailing Address - Phone:317-797-1043
Mailing Address - Fax:
Practice Address - Street 1:1543 RINGGOLD AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-2724
Practice Address - Country:US
Practice Address - Phone:317-797-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst