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General NPI Number Information
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NPI Number | 1659235836
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Entity Type | Individual
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Provider Name | SHELBY JEAN ELLIS BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 611 WALNUT STREET PO BOX 244
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City | MARTINS FERRU
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State | OH
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Zip | 43935-1441
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Country | US
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Telephone | 740-609-5072
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Fax | 740-609-5073
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Provider Business Mailing Address
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Address Line | 611 WALNUT STREET PO BOX 244
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City | MARTINS FERRU
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State | OH
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Zip | 43935-1441
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Country | US
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Telephone | 740-609-5072
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Fax | 740-609-5073
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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 | 1-22-57903
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License Number State | OH
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