Provider Demographics
NPI:1063777936
Name:HENRY, SHELLY LYNN (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:SHELLY LYNN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:8027 COOPER CREEK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-3002
Practice Address - Country:US
Practice Address - Phone:941-477-2080
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019635400Medicaid
FL651119Medicaid
FL624298Medicaid