MEDICARE: SHAPING POSITIVE BEHAVIORS, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	340	TN

General Provider Information

NPI Number	:	1376030148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAPING POSITIVE BEHAVIORS, LLC.

Provider Business Mailing Address
First Line	:	5175 ELMORE RD STE 1
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-5629
Country	:	US
Telephone Number	:	901-503-6170
Fax Number	:	901-284-0408

Provider Business Practice Location Address
First Line	:	5175 ELMORE RD STE 1
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-5629
Country	:	US
Telephone Number	:	901-503-6170
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	STACIA LATORRIA EVANS
Credential	:
Telephone Number	:	731-269-8694

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	05/27/2026

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