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NPI Code Detail

MEDICARE: SHEA ROLLINS MA, BCBA

MEDICARE:   SHEA  ROLLINS  MA, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystTX

General Provider Information

NPI Number : 1134799521
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEA ROLLINS MA, BCBA
Provider Business Mailing Address
First Line : 1144 S TIMBERLINE DR
Second Line :
City : BENBROOK
State : TX
Zip : 76126-3967
Country : US
Telephone Number : 817-888-7699
Fax Number :
Provider Business Practice Location Address
First Line : 4400 OAK PARK LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-9534
Country : US
Telephone Number : 469-892-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2021
Last Update Date : 06/28/2021

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Directions to “ SHEA ROLLINS MA, BCBA” Practice Location

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