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General NPI Number Information
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NPI Number | 1083568406
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Entity Type | Individual
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Provider Name | SHELBY LYNN WAGNER BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 7525 SUMMER CREEK DR SUITE 141
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City | FORT WORTH
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State | TX
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Zip | 76123
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Country | US
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Telephone | 682-267-1913
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Fax |
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Provider Business Mailing Address
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Address Line | 205 HIGH RIDGE CT
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City | GODLEY
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State | TX
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Zip | 76044-1245
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Country | US
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Telephone | 168-226-7191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | TX
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