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Individual

BENNETT SHIPLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCBA

Contact information

Practice address
773 BANDIT TRL, KELLER, TX 76248-0111
(817) 442-9022
Mailing address
2104 GREENBRIAR DR, SOUTHLAKE, TX 76092-8355
(817) 442-9022

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-59870
TX
103K00000X
Behavior Analyst
5123
TN
106S00000X
Behavior Technician
RBT-20-117363
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20-117363
BACB
TX
Enumeration date
07/13/2021
Last updated
02/08/2023
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