Healthcare Provider Details

I. General information

NPI: 1861235475
Provider Name (Legal Business Name): SHAPING BEHAVIOR ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 BLUE MOON DR
COLORADO SPRINGS CO
80924-4212
US

IV. Provider business mailing address

5508 BLUE MOON DR
COLORADO SPRINGS CO
80924-4212
US

V. Phone/Fax

Practice location:
  • Phone: 817-995-8953
  • Fax:
Mailing address:
  • Phone: 817-995-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERICA A HEBERT
Title or Position: CO-FOUNDER/CEO
Credential: BCBA
Phone: 817-995-8953