Provider Demographics
NPI:1336613090
Name:SHELTON, JOSHUA (BCBA)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-5904
Mailing Address - Country:US
Mailing Address - Phone:765-587-5244
Mailing Address - Fax:765-281-6914
Practice Address - Street 1:4105 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5904
Practice Address - Country:US
Practice Address - Phone:765-587-5244
Practice Address - Fax:765-281-6914
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-18-33680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst