Healthcare Provider Details

I. General information

NPI: 1376453464
Provider Name (Legal Business Name): SHELBY NICOLE ADKINS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4456 MANZANITA AVE # 2
CLEARLAKE CA
95422-7200
US

IV. Provider business mailing address

855 WAUGH LN APT A
UKIAH CA
95482-5932
US

V. Phone/Fax

Practice location:
  • Phone: 707-461-5027
  • Fax:
Mailing address:
  • Phone: 415-548-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2845569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: