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General NPI Number Information
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NPI Number | 1689470023
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Entity Type | Individual
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Provider Name | SHELBY BREANN TUCKER LEP, BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 805 E ALAMOS AVE
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City | FRESNO
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State | CA
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Zip | 93704-3104
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Country | US
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Telephone | 559-433-7726
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Fax |
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Provider Business Mailing Address
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Address Line | 805 E ALAMOS AVE
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City | FRESNO
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State | CA
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Zip | 93704-3104
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Country | US
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Telephone | 559-433-7726
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4557
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 220108724
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB330712
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License Number State | CA
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