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General NPI Number Information
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NPI Number | 1104412840
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Entity Type | Individual
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Provider Name | SHELBY GOODEN
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Gender | Female
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 7440 HIGHWAY 92
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City | WOODSTOCK
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State | GA
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Zip | 30189-5235
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Country | US
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Telephone | 770-212-2170
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Fax |
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Provider Business Mailing Address
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Address Line | 911 N GOLIAD ST
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City | ROCKWALL
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State | TX
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Zip | 75087-2230
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-70655
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-51429
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License Number State | TX
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