Provider Demographics
NPI:1376033407
Name:BARKER, SHELBY ELYSE (BCBA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELYSE
Last Name:BARKER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:ELYSE
Other - Last Name:PIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:3435 W 96TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1102
Mailing Address - Country:US
Mailing Address - Phone:317-222-1242
Mailing Address - Fax:
Practice Address - Street 1:3435 W 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1102
Practice Address - Country:US
Practice Address - Phone:317-222-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-17-28626106S00000X
IN1-18-31796103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician