Provider Demographics
NPI:1740521764
Name:SHINABARGER, TRACI L (LCSW, MPA, BCBA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:SHINABARGER
Suffix:
Gender:F
Credentials:LCSW, MPA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4313
Mailing Address - Country:US
Mailing Address - Phone:406-552-5762
Mailing Address - Fax:
Practice Address - Street 1:735 E BROADWAY
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4313
Practice Address - Country:US
Practice Address - Phone:406-552-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC-8471041C0700X
MTBCBA 1-12-11885103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst