Provider Demographics
NPI:1780382986
Name:SHACKELFORD, COLTON JAMES (RBT)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:JAMES
Last Name:SHACKELFORD
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0245
Mailing Address - Country:US
Mailing Address - Phone:406-657-2323
Mailing Address - Fax:406-657-2313
Practice Address - Street 1:1500 UNIVERSITY DR # DRIVE168
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0245
Practice Address - Country:US
Practice Address - Phone:406-657-2323
Practice Address - Fax:406-657-2313
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-258618106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician