Provider Demographics
NPI:1134629520
Name:CARTY-JANIS, SHANNON (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CARTY-JANIS
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:CARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:502-633-1007
Mailing Address - Fax:
Practice Address - Street 1:3761 JOHNSON HALL DR
Practice Address - Street 2:
Practice Address - City:MASONIC HOME
Practice Address - State:KY
Practice Address - Zip Code:40041-9998
Practice Address - Country:US
Practice Address - Phone:502-633-1007
Practice Address - Fax:502-805-1511
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11727679103K00000X
KY239850103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst