Provider Demographics
NPI:1982125365
Name:TONGE, SHAINA M (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:M
Last Name:TONGE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:SHAINA
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1035 EL RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8238
Mailing Address - Country:US
Mailing Address - Phone:720-295-3790
Mailing Address - Fax:877-400-4480
Practice Address - Street 1:1035 EL RANCHO RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:720-295-3790
Practice Address - Fax:877-400-4480
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26084103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst