Healthcare Provider Details

I. General information

NPI: 1659235836
Provider Name (Legal Business Name): SHELBY JEAN ELLIS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 WALNUT STREET PO BOX 244
MARTINS FERRU OH
43935-1441
US

IV. Provider business mailing address

611 WALNUT STREET PO BOX 244
MARTINS FERRU OH
43935-1441
US

V. Phone/Fax

Practice location:
  • Phone: 740-609-5072
  • Fax: 740-609-5073
Mailing address:
  • Phone: 740-609-5072
  • Fax: 740-609-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57903
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: