Provider Demographics
NPI:1306641675
Name:MURDOCK, SHYANN (RBT)
Entity type:Individual
Prefix:
First Name:SHYANN
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 N CROSS LAKES CIR APT A
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-4913
Mailing Address - Country:US
Mailing Address - Phone:765-621-7183
Mailing Address - Fax:
Practice Address - Street 1:810 W 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-1516
Practice Address - Country:US
Practice Address - Phone:765-617-2279
Practice Address - Fax:765-274-5260
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-364113106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician